Jay Bradshaw, Director Maine EMS 1
���� Paramedic Paradox The further one moves from an emergency medical facility The more one may need a higher level of local EMS capability And the less likely that this EMS capability will be available 2
Rural Paramedic Paradox ∗ Financially Less Supportable ∗ Fixed Cost of Paid Crew Fixed Cost of Paid Crew ∗ Availability of Volunteer Paramedics ∗ Operationally Less Supportable ∗ Skill Retention 3
Community Paramedicine Adapting EMS resources to address community health care Adapting EMS resources to address community health care embracing the “ paramedicine paradox ” as one of those and/or public health needs not currently being met and needs. 4
Blueprints for the System of EMS ∗ EMS Systems Act of 1973 5
Blueprints for the System of EMS EMS Agenda for the Future (1996) The Vision Emergency medical services ( EMS ) of the future: Emergency medical services ( EMS ) of the future: ∗ Community-based health management … ∗ Fully integrated with the overall health care system… ∗ Able to identify and modify illness and injury risks.. ∗ Able to provide acute illness and injury care and follow-up, and … ∗ Able to contribute to treatment of chronic conditions and community health monitoring… 6
2004 – “ EMS Based Community Health Services ” Already exist in many settings across the country….. 7
However….. ∗ Not Universal ∗ Volunteer Svcs. ∗ Busy FD Svcs. ∗ Will Evolve Only ∗ As needed ∗ Where needed ∗ How needed 8
Similar; but different ∗ Community Paramedic ∗ Community Paramedicine ∗ Mobile Integrated Health Care 9
Community Paramedicine ∗ IS ∗ A generic concept ∗ A means to fill a temporary or on-going health care need ∗ Expansion of EMS roles and services to assist community health team colleagues ∗ Generally on an episodic, not case management, basis ∗ Generally on an episodic, not case management, basis ∗ IS NOT ∗ An expansion of EMS scope of practice ∗ Just for the Paramedic license level…. ∗ The same in every (or any) community ∗ Competing for community health roles, but leverages the 24/7 presence and mobility of EMS resources in the community 10
Evolving Concept….. ∗ Community Paramedic ∗ A state licensed Paramedic who is certified as graduating from a recognized college program in community paramedicine and operates within the scope of practice for paramedicine and operates within the scope of practice for their licensure level as approved by the state under appropriate medical direction for the nature of their ∗ Episodic Care (e.g. “ Deli Menu ” Approach) practice. 11
Statutory Approaches ∗ No/Minor Statutory Changes – Delegated Practice ∗ No Statutory Change/Current Definitions Work ∗ No Statutory Change/Current Definitions Work ∗ Statutory Changes Needed for Practice and/or Reimbursement 12
Medical Direction ∗ Primary Care & EMS Mix ∗ Flexible Models to Meet Resource Availability ∗ Small, Rural Facilities: Single Physician? ∗ Medium Facilities: 1 PCP & 1 EM/EMS? Medium Facilities: 1 PCP & 1 EM/EMS? ∗ Health Systems: 1 Physician Coordinating Many? ∗ The Balancing Act ∗ When is a patient interaction an EMS event? ∗ When is a patient interaction a CP event? ∗ What happens when an interaction transitions? 13
Supporting CP Programs - $$$ ∗ Currently No Direct Funding Provisions ∗ CMMI Grant Program ∗ Maine: Has Medicaid “ No Transport ” ∗ Minnesota: Medicaid ∗ Minnesota: Medicaid ∗ Future: ∗ Demonstrate Value to: ∗ Current Reimbursement Model Payers ∗ Evolving Accountable Care Organizations ∗ Evolving Medical Home Model Practices ∗ Community Health Colleagues Who Perceive Gaps 14
Others ∗ Colorado - Public Health Nursing Partner Model ∗ Pittsburgh – Home Health Partner Model ∗ Pittsburgh – Home Health Partner Model ∗ San Francisco – “Frequent Flyer” Overutilization ∗ Wake County, NC ∗ Dallas – Fort Worth ∗ Minnesota
Maine CP Project ∗ Collaboration: ∗ Maine EMS (DPS) ∗ Maine Office of Rural Health (DHHS) ∗ Maine Office of Rural Health (DHHS) ∗ Components (Over 3 Years) ∗ On-Going Task Force ∗ Pilot Project Approach With Uniform: ∗ Medical Direction/Quality Improvement Processes ∗ Prospective Research Methodology ∗ Integration Into Community Health Teams
Maine CP Project ∗ Components (continued) ∗ Pilot Requirements ∗ Current Paramedic/Other Provider Capacity ∗ Relationship With Primary Care Practice Site(s) ∗ Relationship With Primary Care Practice Site(s) ∗ Willingness of Site To ∗ Provide Medical Oversight/QI ∗ Access Data on Patient Population (MHMC or other) ∗ Solicit Pilots, Assist, and Monitor Reporting ∗ Work with Payers
Pilot CP Project Models ∗ Community Paramedic Model ∗ Licensed Paramedic ∗ 100-200 Hour College-Based Program ∗ Primary Care/Emergency Medicine Oversight ∗ Primary Care/Emergency Medicine Oversight ∗ Integrated in Community Health Team ∗ Enabled/Extended Health Services Model ∗ Licensed Providers Within Their Scope ∗ Limited/Selected Services ∗ Additional Training, and Oversight as Appropriate ∗ Integrated in Community Health Team
CP Pilot Projects ∗ Greater Kennebec County ∗ Castine FD (MGMC, Delta, Winthrop) (MGMC, Delta, Winthrop) ∗ Calais FD ∗ Calais FD ∗ Central Lincoln County ∗ Crown Amb (Miles Memorial, CLC, ∗ Mayo (Dover-Foxcroft) Waldoboro, Boothbay) ∗ C.A.Dean (Greenville) ∗ North East Mobile Health ∗ Northstar (Farmington) ∗ St. George Amb ∗ United Amb (Lew/Aub) ∗ Searsport Amb ��
What’s Next? ∗ Objective evaluation (USM Muskie School) ∗ Link CP data with MHDO, others ∗ Expand pilot sites? ∗ EMS Rules? ∗ Reimbursement ��
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