The Iowa EMS Association is partnering with the Iowa Department of
Public Health Bureau of Emergency & Trauma Services and stakeholders
from a variety of state partner agencies with a mission to develop
alliances to mobilize community action for healthcare access. Goals
identified by this stakeholder group include:
The recognition of EMS as an active partner in community needs
The ability of EMS to fill community healthcare gaps;
The avoidance of service duplication; and
The strengthening of health infrastructure by improving access to
The Iowa EMS Association has agreed to post articles relating to
Community Paramedicine/Mobile Integrated Healthcare on its website
to improve access to this important information for EMS providers.
How EMS benefits from hospital
Increased economic pressure
on hospitals provides the opportunity to reconfigure the role of EMS
within an integrated health care system
By Susanna J. Smith
EMS1.com Nov. 17, 2014
Last month, hospital readmissions penalties under the Affordable
Care Act were extended to include patients readmitted within 30 days
of treatment for chronic obstructive pulmonary disease or total hip
or knee replacement. ...
Paramedics Step Up to Cut Hospital Readmissions
Emergency medical workers find a new lucrative
line of business: helping hospitals potentially save millions of
By Alan Neuhauser
USNews.com Oct. 9, 2014
The cupboards were bare, so he did what anyone would do – he went
Except this wasn’t his home. He wasn’t even buying food for himself.
Instead, the man is a paramedic with the Carmel, Indiana, Fire
Department, a fast-growing town of 86,000 just north of
Indianapolis. Carmel Fire Chief Matt Hoffman said his staffer wasn't
responding to an emergency – he was preventing one, visiting one of
the 80-plus former 911 patients participating in the department’s
new Mobile Integrated Health Care program.
A community paramedic with Colorado's Eagle County Paramedic
Services checks on a patient.
“All she had was Campbell’s chicken noodle soup, which is really
high in sodium and really bad for congestive heart patients like her
– that’s the last thing in the world you would want that person to
eat,” Hoffman recounts. “So of his own volition, this paramedic
provided some better menu options so that she would not fall into
another congestive-heart-failure episode and be transported back to
In the past decade, according to the Joint National EMS Leadership
Forum, close to 300 fire departments, ambulance services and
hospital systems nationwide have launched programs like Carmel’s,
initiatives commonly known as community paramedic or community
Under President Barack Obama’s Affordable Care Act of 2010,
hospitals can be fined if a patient has to be treated again for the
same condition shortly after being discharged. Last year, 18 percent
of Medicare patients who were hospitalized and then discharged had
to be readmitted, Kaiser Health News reported. The return visits
cost the agency about $26 billion.
Last year, a program that saw 739 patients in rural Colorado helped
save an estimated $313,834 in costs between hospitals, insurers and
patients. A small pilot program in Minnesota reduced ER readmissions
for high-risk patients from roughly 20 percent to just 3 percent.
And of the roughly 80 patients that Carmel's community paramedics
have seen since July 1, just two have called 911 again for the same
And one week after Medicare announced it would fine more than 2,000
hospitals for readmitting too many patients last year, Hoffman hopes
that community paramedicine's apparent success rates will attract
millions of dollars in funding from local hospitals eager to reduce
future Medicare penalties. That money, he says, could support
operations budget for the entire fire department, without a single
cent of taxpayer money.
“It’s looking at the delivery of health care in the community in an
entirely new way,” says Michael Kaufmann, medical director for the
Carmel Fire Department and St. Vincent Carmel Hospital's Emergency
Community paramedicine, in one sense, brings back the black-bag
home-doctor visits of yore: rather than wait for a call to 911,
paramedics swing by former patients' homes. They’ll check vital
signs, make sure patients are taking their medications, look for
potential hazards like mold in the home or tricky stairs. In some
programs, the paramedics may administer vaccines, draw blood for
tests, and drive patients to the pharmacy or local clinic rather
than the emergency room.
The Carmel Fire Department boasts more than 50
firefighter-paramedics who cover the city's roughly 50 miles, plus
nearby Clay Township.
The Carmel, Indiana, Fire Department, seen here battling an
apartment fire in 2008, launched its community paramedic program
“We have people that we run on, on a regular basis, dozens of times
a month, and there has to be a system to help them take care of
themselves or at least find them other options than the emergency
room,” Hoffman says. “If we can take that preventative measure, it
saves our resources for the times we desperately need them.”
Plus, adds Susan Long, director of clinical services for Allina
Health EMS in Minnesota, which has implemented its own community
paramedic program, “hospitals don’t get dinged for the
And that, fire and EMS agencies hope, could be a potentially
lucrative opportunity for their cash-strapped ambulance corps.
“I run about a $3 million budget, and about half of that is
supported from ambulance fees,” Hoffman says. “My goal is that my
entire operations budget would be based on user fees” from the three
hospitals in his jurisdiction that could pay his department for the
community paramedicine program, instead of forking over millions
more to the government for excessive ER visits.
Last week, Medicare declared it would penalize 2,610 hospitals,
docking them a portion of every Medicare payment that goes toward a
patient’s stay – fines expected to total about $438 million, Kaiser
Those penalties, as intended, has created huge interest in
preventative care. As Chris Montera of Colorado’s Eagle County
Paramedic Services describes, paramedics have “come in to help them
[the hospitals] fill those gaps.”
Eagle County founded the country’s first rural community
paramedicine program in 2009. The service covers 1,692 square miles
and helps bring basic care to hundreds of far flung patients who
might otherwise have trouble getting to a clinic or pharmacy. The
patients, referred to the program by a physician, are chiefly the
elderly – the median age last year was 60 – but those with mobility
or behavioral issues also use the service, too.
Other programs, like Carmel’s, are based in cities: community
paramedics in Fort Worth, Texas, and Wake County, North Carolina,
also keep an eye on patients.
“The physician in the clinic or the hospital doesn't necessarily see
what the patient is doing at home,” says Allina’s Long. "So having
the paramedic see that the patient is going up three flights of
stairs every day or eating high-sodium food, it’s another connection
point to really improve the health of the patient.”
Many if not most of the programs are still figuring out the best way
to pay for them. There are two different models; some, like Eagle
County, hire community paramedics exclusively for the program while
others, like Carmel, ask their paramedics to see patients between
"We're using our extra capacity," Carmel Mayor James Brainard says.
Minnesota is the only state to have authorized reimbursements
through Medicaid. Programs in other states, like Carmel's and Eagle
County's, want partnerships with hospitals.
For now, though, Eagle County's Montera says, "it's still very
There are skeptics, too. Nursing groups, for example, have voiced
some concern that community paramedicine programs could eliminate
some home health-care jobs. Members of the International Association
of Firefighters also initially argued that the program might
unfairly impose additional duties on firefighters and paramedics. In
July, though, the union adopted a resolution in favor of community
"Engaging our members, our firefighter-paramedics and EMTs, to be
even more integrated into the community and to be even higher value
and importance – we really see it as expanding our service as we
have in so many areas," IAFF general president Harold Schaitberger
"In the 1970s, fire departments only fought fires, and then we
really started working on fire prevention," he says. "Now because of
the Affordable Care Act, we're pretty much doing the same thing.
We're trying to cure these patients or treat these patients before
they need treatment."