News & Updates

Source Article from USFA Citing Prehospital and Disaster Medicine | Comments Courtesy of Matt Zavadsky 

Very nice findings in of a study in Prehospital and Disaster Medicine, and cited by the US Fire Administration. 

A couple of interesting statements in the study and the citation:

“As health care systems in the United States have become pressured to provide greater value, they have embraced the adoption of innovative population health solutions. One of these initiatives utilizes pre-hospital personnel in the community as an extension of the traditional health care system.”

“Training in basic disaster response needs should be incorporated into the curricula and community disaster planning should identify how these providers may be able to benefit their local communities.”

Tip of the hat to Mark Babson from Ada County Paramedics in Idaho (and a member of the NAEMT EMS 3.0 Committee) for sharing this information.

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EMS Mobile Integrated Health during disaster response

How one community's MIH providers assisted with patient care during severe flooding

Nov. 15, 2018

https://www.usfa.fema.gov/current_events/111518.html

In many communities across the country, Emergency Medical Services (EMS) provide preventative health care to help reduce unnecessary and costly trips to the emergency room and ensuing hospital admissions. EMS operating in a Mobile Integrated Health (MIH) role help patients with chronic conditions in their homes, divert ambulance calls to outpatient providers, and in some communities, use telemedicine to connect their patients with physicians from their homes.

But what if a disaster should strike? How might MIH providers best assist in the response effort?

A recent study¹ was the first to examine the work of MIH providers — Richland County (South Carolina) EMS — during an October 2015 response to severe flooding.

Study findings

MIH providers were able to meet vulnerable patients' health needs in severe flooding conditions by:

1. Reconnecting individuals in emergency shelters with:
   • Lost medications.
   • Alternative housing or social services.
   • Transportation to relocate them with family outside of the affected area.
   • Other essential health care.
2. Readily identifying to local authorities those patients who required in-person wellness checks.
3. Delivering food and water to patients they knew were unable to leave their homes due to a disability.
4. Providing uninterrupted power supply for home ventilators, left ventricular assist devices, and other medical equipment.

EMS physicians augmented MIH services during the flood response by performing telephone triage and self-care instruction to patients cut off from EMS. They responded to the field and provided consultation to MIH as needed.

Research takeaways for MIH providers

• Include disaster response in the MIH training curriculum.
• Help patients prepare for disasters by emphasizing the need for an evacuation plan and to safeguard adequate supplies of medications and durable medical equipment.
• Identify ahead of time community members with complex medical needs, such as people who require access to uninterrupted power for life-sustaining medical equipment.

LEARN MORE ABOUT THIS RESEARCH

Summary information for this article was provided by the NETC Library. You can request access to this research study by contacting the library at netclrc@fema.dhs.gov.

Explore library services

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Utilization of Mobile Integrated Health Providers During a Flood Disaster in South Carolina (USA)

Christopher E. Gainey ^(a1), Heather A. Brown ^(a1) and William C. Gerard ^(a1) 

https://doi.org/10.1017/S1049023X18000572

Abstract

As health care systems in the United States have become pressured to provide greater value, they have embraced the adoption of innovative population health solutions. One of these initiatives utilizes pre-hospital personnel in the community as an extension of the traditional health care system. These programs have been labeled as Community Paramedicine (CP) and Mobile Integrated Health (MIH). While variation exists amongst these programs, generally efforts are targeted at individuals with high rates of health care utilization. By assisting with chronic disease management and addressing the social determinants of health care, these programs have been effective in decreasing Emergency Medical Services (EMS) utilization, emergency department visits, and hospital admissions for enrolled patients.

The actual training, roles, and structure of these programs vary according to state oversight and community needs, and while numerous reports describe the novel role these teams play in population health, their utilization during a disaster response has not been previously described. This report describes a major flooding event in October 2015 in Columbia, South Carolina (USA). While typical disaster mitigation and response efforts were employed, it became clear during the response that the MIH providers were well-equipped to assist with unique patient and public health needs. Given their already well-established connections with various community health providers and social assistance resources, the MIH team was able to reconnect patients with lost medications and durable medical equipment, connect patients with alternative housing options, and arrange access to outpatient resources for management of chronic illness.

Mobile integrated health teams are a potentially effective resource in a disaster response, given their connections with a variety of community resources along with a unique combination of training in both disease management and social determinants of health. As roles for these providers are more clearly defined and training curricula become more developed, there appears to be a unique role for these providers in mitigating morbidity and decreasing costs in the post-disaster response. Training in basic disaster response needs should be incorporated into the curricula and community disaster planning should identify how these providers may be able to benefit their local communities.

Gainey CE, Brown HA, Gerard WC. Utilization of mobile integrated health providers during a flood disaster in South Carolina (USA). Prehosp Disaster Med.2018;33(4):432–435

Associated Press Source Article | Comments Courtesy of Matt Zavadsky

Calumet Park is a community of ~7,500 people in Cook County, IL.

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Calumet Park readies for privatized fire-protection services

The Associated Press

November 23, 2018

https://apnews.com/38d0b9674b0d4d00bcd042a644ea7b29

CALUMET PARK, Ill. (AP) — Calumet Park officials have hired a private firm to provide fire and ambulance services to spare a tight budget, in a move the village attorney says could become the norm in Chicago’s south suburbs.

The (Tinley Park) Daily Southtown reports the village board approved a separation agreement this month with its firefighters union and a five-year contract with Kurtz Ambulance Service for fire protection and ambulance services.

“It’s going to cause a chain reaction in the south suburbs with the communities that just can’t afford to pay the high salaries, the overtime and the equipment,” said Village Attorney Burt Odelson, noting that he was in discussions with three other south suburban communities about outsourcing their fire departments.

Odelson, who previously engineered privatization in North Riverside that state labor regulators overturned, estimated savings at $500,000 annually.

Kurtz takes over Dec. 1. It will supply 12 full-time staff members who are firefighters and paramedics in four-person shifts. The village currently has 30 part-time firefighters. Four current village firefighters will join the Kurtz staff.

Calumet Park will pay $825,000 in the first year. It increases gradually each year to top out at $925,000.

Mayor Ronald Denson said he never questioned the village department’s quality. But he says with dwindling revenue sources, “We have to make some changes if we’re going to survive.”

WNEP Source Article | Comments Courtesy of Matt Zavadsky

Nice local news story about Geisinger’s program.  The video interview is very cute!

Dr. Doug Kupas shared the following relating to the program, and Ms. Miller’s perception:

“Although our Geisinger at Home includes physicians, nurses, physician assistants, MIH paramedics, pharmacists, mental health, dieticians, palliative care, and community health workers, the clip did not highlight all of these. It was cool that the patient that they interviewed focused on the paramedics.”

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Healthwatch 16: Geisinger at Home

https://wnep.com/2018/11/20/healthwatch-16-geisinger-at-home/

JESSUP, Pa. -- It may be an old idea, but a new program is taking off for a hospital system in our area.

Geisinger at Home is just what it sounds like -- a team of health care professionals treating a patient in his or her own home.

Angels are all over Jeanette Miller's house in Jessup, but she says some of her favorites wear scrubs.

"I had to have the paramedics come and shoot that intravenous into my arm and give me the liquid medicine. Thank God for Christine and Dr. Wylie. They really helped me. They were my angels," Jeanette said.

89-year-old Jeannette is one of the 1,200 Geisinger patients now enrolled in a program called Geisinger at Home.

"It's not for everyone. We focus on our fragile and medically complex patients," explained Kristine Collins, R.N.

Jeannette has had heart trouble and fainted once in her kitchen. She's an example of someone who may have a hard time getting medical help on her own, but whose issues can be managed.

"It's not just for when the patient is sick at home, although that's a great benefit and it benefitted Jeanette here, but we try to keep them as healthy as possible," said Collins.

"Patients have complex health conditions, multiple conditions, and they have trouble getting out of their home to come to a clinic or a practice to get care. That really was the impetus to get us thinking about a new care model," said Janet Tomcavage, Geisinger's chief population health officer.

She explains Geisinger at Home started in April. Health officials identify and reach out to people like Jeannette who have a number of hospital stays or ER visits offering an extra layer of care, 24/7.

And she points out it's a way to cut costs, too.

"A lot of times patients use the ED for their care and if we can get upstream we can make a difference in outcomes and lower expenses as well," Tomcavage said.

Officials say Geisinger at Home is not just doctors or nurses. The team can include dieticians and social workers, too.

That gives them a better picture of what may be happening at home, such as food insecurities, or safety issues.

Incidental Economist Source Article | Comments Courtesy of Matt Zavadsky

Very interesting commentary in the Incidental Economist.  Definitely worth investing the 6 minutes to watch the video.

Tip of the hat to Gregg Margolis for sharing this find!

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Healthcare Triage: A Lyft to the Hospital: Can Ride Sharing Replace Ambulances?

November 20, 2018

By Aaron Carroll

https://theincidentaleconomist.com/wordpress/healthcare-triage-a-lyft-to-the-hospital-can-ride-sharing-replace-ambulances/

An ambulance ride of just a few miles can cost thousands of dollars, and a lot of it may not be covered by insurance.

With ride-hailing services like Uber or Lyft far cheaper and now available within minutes in many areas, would using one instead be a good idea?

Perhaps surprisingly, the answer in many cases is yes. That’s the topic of this week’s HCT.

FierceHealthcare Source Article | Comments courtesy of Matt Zavadsky

Interesting comments from Sec. Azar, especially with the recent pace of activity from CMS and CMMI conducting conference calls with several EMS organization, requesting SOPs, protocols, outcome measures and ROI determinations for things like Ambulance Transport Alternatives, Community Paramedicine and 9-1-1 Nurse Triage. 

Even interviewing current payers who are paying EMS agencies for these transformational services.

Interesting!

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Why HHS wants Medicare Advantage plans to pay for home modifications, transportation for seniors

by Tina Reed | 

Nov 14, 2018 1:27pm

https://www.fiercehealthcare.com/hospitals-health-systems/azar-and-social-determinants-health

Starting next year, Medicare Advantage plans will be allowed to pay for a wider array of health-related benefits including transportation and home health visits, Health and Human Services Secretary Alex Azar said on Wednesday.

And by 2020, HHS will extend the range of benefits even further to allow MA plans to cover benefits such as home modifications and home-delivered meals, he said. 

Why?

"These interventions can keep seniors out of the hospital, which we are increasingly realizing is not just a cost saver but actually an important way to protect their health, too," Azar said. "If seniors do end up going to the hospital, making sure they can get out as soon as possible with the appropriate rehab services is crucial to good outcomes and low cost as well. If a senior can be accommodated at home rather than an inpatient rehab facility or a [skilled nursing facility], they should be."

Azar was speaking in D.C. at a healthcare policy symposium focused on social determinants of health hosted by Utah-based Intermountain Healthcare and the Orrin G. Hatch Foundation's Hatch Center.

He was focusing on the agency's approach to social determinants a day after it was announced that CMS would begin allowing states to cover a broader range of mental health services under Medicaid. Specifically, CMS would consider Medicaid demonstration waivers covering short-term stays for acute care provided in psychiatric hospitals or residential treatment centers in return for states expanding access to community-based mental health services.

As he spoke, Azar also teased new focus areas coming from CMS' Center for Medicare and Medicaid Innovation (CMMI) for helping vulnerable populations.

“What if we provided more than connections and referrals? What if we provided solutions for the whole person including addressing housing, nutrition and other social needs all together?" Azar said. "What if we gave organizations who work with us more flexibility so they can pay beneficiaries' rent if they are in unstable housing or make sure that a diabetic has access to and can afford nutritious food? If that sounds like an exciting idea, then stay tuned to what CMMI is up to.” 

Azar said the moves are part of a broader push under the Trump administration to better harness the flexibility of existing programs to address social determinants that drive up health costs and hurt patient outcomes. 

“It probably won’t surprise you to hear that this administration is thinking about how to improve healthcare and social services while preserving what is unique about our American system: its decentralized nature and the key role played by the private sector and civil society," Azar said. “But it may surprise you that we are thinking about this very specifically in the context of social determinants of health. We are deeply interested in this question, and thinking about how to improve health and human services through greater integration has been a priority throughout all of our work."

Medicare Advantage (MA) plans are offered by private companies approved by Medicare and paid by Medicare to cover patients' benefits including hospital and medical insurance.

While the idea has been lauded by health experts, Kaiser Health News reported few seniors will actually be able to access these changes. Medicare officials estimate about 7 percent of Advantage members — 1.5 million people — will have access, KHN reported.

Companies offering MA plans both compete for patients and hold the risk for them, Azar said. "They've got incentives to offer benefits that are both appealing to their members and that will bring down healthcare costs whether those benefits are traditionally thought of as health services or not," Azar said. "The key is just that we need to give them the flexibility to do this, which we generally don't do."

mHealth Intelligence Source Article | Comments Courtesy of Matt Zavadsky

Ohio Hospital Using Telehealth to Tackle 911 Calls, ER Overcrowding

Atrium Medical Center is partnering with the local fire department to launch a telehealth service aimed at local residents who frequently dial 911. The community paramedicine program is one of hundreds popping up across the country.

By Eric Wicklund

November 14, 2018

https://mhealthintelligence.com/news/ohio-hospital-using-telehealth-to-tackle-911-calls-er-overcrowding

An Ohio hospital is partnering with the local fire department and Miami University Oxford to launch a telehealth program aimed at the most frequent users of the 911 emergency system.

Middletown-based Atrium Medical Center and the  Monroe Fire Department are launching a community paramedicine pilot program in the southwest Ohio community, with the goal of bringing connected health services to the region’s most frail and homebound residents.

Also known as Mobile Integrated Health, the community paramedicine program involves sending healthcare providers – usually paramedics – on scheduled visits to the homes of people who most often call 911. The paramedics perform health and wellness checks using telemedicine equipment, check out the home for potential health hazards and educate residents on community health resources.

Atrium officials say the program aims not only to reduce unnecessary ambulance calls and ER visits, but to improve the health and wellness of residents who have problems accessing regular healthcare services.

As part of the program, Miami University students in social work programs will participate in the visits to chart their effectiveness. And the teams will carry a telemedicine kit developed by HNC Virtual Solutions.

“Not only is the patient’s health and prognosis proactively improved through this revolutionary approach, but healthcare costs will be reduced, and the hospital’s existing healthcare delivery system will be enhanced by freeing up further resources to respond to more significant medical emergencies,” Julian Shaya, the company’s executive vice president, said in a press release. “This virtual solutions tool is a game changer for healthcare.”

As of mid-2017, some 260 EMS programs across the country were using some sort of community paramedicine program, up from 100 programs in 2014, according to the National Association of Emergency Medical Technicians.

“Having the opportunity to work with patients in the homes or work sites gives us the chance to be proactive instead of reactive,” Amie Allison, EMS Director for Montana’s Glacier County, said when the Glacier County Community Health Center launched its first-in-the state Integrated Mobile Health Service Program in early 2017.

Earlier this year in New Mexico, American Medical Response unveiled its Mobile Integrated Healthcare (MIH) program in Valencia County following talks with Blue Cross Blue Shield of New Mexico and Molina Healthcare, which will be funding the program for its members.

“Each assessment takes about an hour, but can vary in length,” Shelley Kleinfeld, AMR’s MIH supervisor for New Mexico, told the Valencia County News Bulletin.  “It differs from the assessments done traditionally by EMS providers dealing with acute injuries or illnesses. It focuses more on the whole well-being of the individual providing resources, services and education to the patients so they can better manage their health.”

“When doing an assessment, we perform a risk assessment, needs assessment, fall assessment, and assess patients’ current needs,” she added. “Community paramedics know resources and services that are available in the community and can assist patients to better utilize them. During the needs assessment we can determine if patient is urgently in need of something, whether it’s a food box, water, medications and durable medical equipment. The community medic provider can than help the patients to quickly obtain those resources.”

In Milwaukee, meanwhile, a program launched in 2015 by the Milwaukee Fire Department has reduced 911 calls from so-called “frequent flyers” by more than 50 percent over the past two years.

One variation of the service, Houston’s Project Ethan (Emergency TeleHealth And Navigation), launched in 2014, sends first responders with telehealth equipment to the scene of a 911 call to assess the caller before deciding on transport.

Learn what high performance, high value EMS means to MedStar Mobile Healthcare CEO and AIMHI President Doug Hooten.

Learn what high performance EMS means to AIMHI President-Elect Chip Decker of Richmond Ambulance Authority.

Modern Healthcare Source Article | Comments courtesy of Matt Zavadsky

Mixed issues here – on one hand, limited access to primary care may exacerbate health issues in this population, potentially resulting in more acute care use, including ambulance.  On another hand, this may lead to an acceleration of Medicaid potentially paying for EMS-Based MIH services for prevention and patient navigation as a way to meet the Triple Aim®.

The inclusion of non-emergency ambulance transportation has been undetermined in this policy.  Some officials have indicated it was not, but other indicated it did include non-emergency ambulance transportation.

CMS is developing a rule that could curtail Medicaid transportation access

By Virgil Dickson  | November 7, 2018

https://www.modernhealthcare.com/article/20181107/NEWS/181109932  

The CMS is drafting a proposed rule that would make it easier for states to stop paying for non-emergent medical transportation for Medicaid beneficiaries, a move that could drastically cut into providers' revenue.

While details of the potential rulemaking are scarce, a notice on the White House's Office of Management and Budget website said the regulation is projected to be released in May 2019.

Just the suggestion that states could cut Medicaid transportation to medical appointments already has providers on edge. Annual Medicaid spending for these trips is around $3 billion, with roughly 103 million non-emergent medical trips each year, according to researchers.

Medicaid enrollees already have a high no-show rate, and that could get worse if the CMS finalizes the rule, according to Dr. Theresa Rohr-Kirchgraber, a practicing pediatrician in Indianapolis and associate professor of clinical internal medicine and pediatrics at Indiana University.

Many Medicaid enrollees lack access to vehicles due to their low incomes. There are also few public transportation options in Indiana, especially in rural areas, Rohr-Kirchgraber said.

"Our feet are really held to the fire that we have high productivity in terms of the number of patients we have to see," she said. "We're the ones that are making the money for our institutions, and we can't we can't afford to keep our doors open if we can't get our patients in."

Currently, states have to obtain a waiver from the CMS if they don't offer non-emergent transportation services. The Trump administration first floated the idea of changing that policy earlier this year in its 2019 budget proposals.

Non-emergent transport to medical appointments has been a mandatory Medicaid benefit since the program's inception in 1965. 

Iowa and Indiana are the only states with a waiver to opt out of providing transportation. Kentucky and Massachusetts have both asked the CMS for similar permission.

It's unclear whether patients' health declines if Medicaid doesn't pay for rides to medical care. A February 2016 report from the Lewin Group said the impact of the transportation benefit waiver in Indiana has been minimal. Most beneficiaries could find other forms of transportation not paid for by Medicaid. Of the 286 beneficiaries interviewed, 11% cited lack of transportation as their reason for missing appointments. A report from Iowa had similar findings.

But the Medical Transportation Access Coalition, a group made up of advocates, transportation providers and managed-care plans, noted that these waivers largely targeted adults who became eligible under Medicaid expansion and had not previously relied on the non-emergency transportation benefit.

The group insists that making it easier for states to opt out of offering these services will harm access to care.

Medicaid enrollees regularly use the benefit to get to dialysis, substance abuse treatments and chronic care visits for diabetes. A survey of Medicaid enrollees last summer by the coalition revealed that low-income patients found it critical to their day-to-day lives. 

"Over half the trips taken today are for life-sustaining treatments," said Tricia Beckmann Faegre, an adviser to the coalition. "Some said that they would die or probably die if they didn't have transportation." Medicaid saved more than $40 million in hospitalization and other medical costs for patients receiving rides to dialysis and wound care treatments, according to a report by the coalition.

It's unclear if the CMS has the authority to make this change to transportation benefits, according to Eliot Fishman, who oversaw 1115 waivers under the Obama administration and is now senior director of health policy at Families USA.

"Making NEMT optional hasn't been tested in court," Fishman said. "If the administration goes in that direction, I expect there will be a legal challenge."

The CMS does not comment on pending rulemakings, according to a spokesman.

Longview News-Journal Source Article | Comments courtesy of Matt Zavadsky

Hats off to our Texas neighbors!

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Longview starts pilot program to reduce EMS trips for high-volume patients

By Jimmy Daniell Isaac

Nov 7, 2018

Emergency and mental health authorities are building toward a multiagency pilot program aimed at high-volume patients of local ambulance services.

The program currently is unstaffed, but Community HealthCore is seeking grant funding with help from Longview health systems and the fire department’s Emergency Medical Services Division to pay for what is described as a proactive approach to patient care.

The approach involves using in-home assessments to identify the needs of patients with the highest number of ambulance trips to local emergency rooms and other health centers — some who average more than 20 ambulance rides a month.

“We had quite a few of those that use our ambulances quite often,” Longview EMS Section Chief Amy Dodgen said during a meeting Tuesday of the city’s EMS Advisory Board.

The program targets people who call for emergency services with issues that can be served by a number of other agencies besides an ER visit, she said.

EMS personnel will continue responding to 911 calls and transporting patients who need emergency room services, she said, but the goal of the program is to determine if the patient might, instead, need social, mental health or other services for issues not physical in nature. Those issues could be anxiety over where their next meal might come from or how they’ll pay a utility bill, which is why several social service agencies are involved in the program, Dodgen said.

“We really want to solve their problems (and) what they’re needing, not just be a Band-Aid,” she said. “We have awesome people and awesome services in Longview. We’ve just got to connect people to them, and some people need assistance with that.”

The EMS Advisory Board is made up of local hospital officials, health agents and first responders who advise the Longview City Council on matters dealing with EMS responsibilities such as financial and manpower investment priorities.

Advocates hope to hear by the end of the year whether the Fort Worth-based Episcopal Health Foundation awards a grant to the local program — currently called the Gregg County Wellness Collaborative.

Dodgen, a city staff liaison to the board, told members that a 270-page report of patients who used Longview ambulance services at least five times a month last year included one patient who took about 120 ambulance rides in one year.

“That same patient is at 72 (trips) this year for 2018,” she said. “These patients, they’re the driving force behind the community health care medicine program that we’re wanting to start.”

Community health care medicine programs have been tried in other cities and can be tailored to fit the Longview area’s specific needs, Dodgen said. It’s a partnership involving local hospitals and EMS agencies.

“For Longview, the concept would be to take these high utilizers and go into their home with their permission and meet with them and see what we can do to mitigate their issues,” she said.

A pilot program has been initiated with about five of the top ambulance users in Longview, including the highest user, who once averaged between 20 and 30 ambulance calls a month but has since reduced to about 10 times a month, Dodgen said, adding, “Although there were patient contacts with her, we didn’t transport her to the hospital as many times.”

Advocates hope the program develops into a way to help patients who need assistance but do not need an emergency room visit.

“Currently, EMS does not get paid if we don’t transport,” Dodgen said.