Community paramedicine services help reduce emergency department readmission rates

In some rural areas of the United States, where hospitals and doctor’s offices are few and far between, people often rely on 911 to get basic medical care.

Experts say this is a problem for patients and hospitals, but a growing model called community paramedicine aims to fix it by having paramedics regularly check on people before a health problem develops. emergency.

One such program takes place in the small desert town of Terlingua, Texas, where Susan Martin is chief of the local emergency medical services department. His small team of fewer than 10 people responds to 911 calls in a dusty, rural 3,000-square-mile area of ​​West Texas.

“A lot of what we’re seeing now with the heat is environmental: some dehydration, some heat exhaustion, things like that,” she said.

Martin said they also get calls from people with chronic health issues.

“Some patients don’t understand their medications,” she said. “(That means) ‘I don’t feel good on them, so I don’t want to take them, so I don’t take them, and I end up getting called to 911.’”

The nearest hospital is over an hour away, allowing the local EMS team’s only ambulance to be tied up for much of the day on an emergency call.

That’s largely why Martin’s team started a “community paramedicine” program, in which paramedics regularly check on people with known health problems—that is, patients who may not see the doctor as often as they should.

“A lot of people here are really reclusive,” said Alexandria Hollenbeck, one of the local paramedics. “They’re usually older people or people with chronic conditions, like high blood pressure or COPD.”

A 2023 survey by a national group of paramedics counted more than 150 of these types of community paramedic programs across the country. It’s a growing health care model championed by EMS agencies and hospitals at a time when some advocates say rural health care is facing a crisis.

Adrian Billings is a longtime West Texas physician and rural health expert at Texas Tech University.

“This area is one of the most underserved health care areas in our state,” he said.

For patients, Billings said, routine paramedic checks at home can avoid costly emergency room visits. Hospitals want to avoid this, too, because they face penalties when too many patients return to the emergency room soon after discharge. This is called readmission.

“From a financial perspective, community paramedicine programs help reduce readmissions which can be very costly for hospitals,” Billings said.

A 2022 KFF Health News analysis reported $320 million in hospital readmission penalties nationwide.

But while paramedical programs can provide significant cost savings, preventative care like this requires an upfront investment.

“The EMS-based community paramedicine business model is very difficult,” said Matt Zavadsky, a longtime emergency medicine professional in Texas who now works for a national consulting firm for emergency medical services operations.

He said insurers — Medicare, Medicaid and private insurers — generally do not cover paramedics making house calls.

“So we have EMTs and paramedics across the country who are doing the right thing in trying to work with patients to avoid unnecessary emergency room visits, but yet they are not eligible for reimbursement,” he said. -he declares.

The new paramedicine program in the small town of Terlingua is being funded as part of a broader $5 million rural development grant from the U.S. Department of Agriculture, with no guarantee of long-term funding.

“Being able to demonstrate to payers that these programs are more cost-effective than a 911 call to the emergency service will be crucial for these rural communities to be able to maintain these exceptional programs,” Zavadsky said.

He hopes that with time and data, community paramedicine programs will be able to prove their value to health insurers.