Derek Franz

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February 13, 2013
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Health care of the future

The Community Paramedic program is starting to prove its viability just in time.

With the looming national health care reform, the 18-month-old CP program is fast becoming part of the solution for making health care more affordable and accessible.

Vail Valley Medical Center and the Eagle County School District recently partnered with the CP program. The county's Department of Health and Human Services is also utilizing the service.

"Those three things are keeping us really busy right now on top of our initial case load," said Community Paramedic Kevin Creek, who has mostly been the only CP making house calls since the program officially launched in June 2011.

That's about to change, however. Colorado Mountain College is wrapping up a pilot curriculum that certifies community paramedics. More than 100 students from all over the country enrolled last year and are now completing their clinical experience. Four graduates from that class will be working with Creek very soon.

Not only that, Eagle County Paramedic Services, which runs the CP program, is seeking sponsors to introduce state legislation for the program. A similar program in Minnesota has already been legislated and that could help pave the way for Colorado. If that happens, the program would be reimbursed from insurers such as Medicaid, Medicare and Accountable Care Organizations.

ECPS encompasses what were previously two ambulance districts - Eagle County Ambulance District and Western Eagle County Ambulance District, which merged last fall.

The basic premise of the CP program is preventative medicine. A Community Paramedic does not replace the specialized services available in a home health care model or physician office, but is an extension of a patient's primary health care.

"We don't want to compete for patients - we want to make sure people are getting access to appropriate care," said ECPS Manager Chris Montera.

A CP can make house visits that a doctor can't, take vital signs, administer treatment, make sure the patient is taking medications properly and that the living conditions are ideal. A CP may also refer someone to the appropriate health care provider.

"A doctor doesn't see how a patient is at home, but we do," Creek said.

Seeing a patient in the home helps address small problems before they become big ones that could result in an emergency trip to the hospital or worse.

The program not only helps save quality of life, it saves money for patients and the health care system. Between September 2010 and June 2012, the Eagle County CP program made 97 visits to 36 patients. In that time, 47 physician visits, 15 ambulance transports, 13 ER visits, three hospital admissions/readmissions and 244 skilled nursing days were prevented, according to Anne Robinson, a public health nurse consultant working with ECPS on the program. Robinson said those preventions add up to an average initial cost savings of $1,279 per visit, $3,446 per patient and a total of $124,071 saved in health care costs.

On Monday, Creek visited a patient who had been referred two weeks ago. He checked her vitals and noticed a problem with one of the readings. He immediately called the patient's doctor to see if she needed a higher dose of medication than normal.

Those are the type of details that might go unnoticed much longer otherwise and result in a more serious health condition.

"I typically have to call a doctor 20 percent of the time to confirm changes in medication or to report abnormal findings," Creek said.

The CP program's partnership with Vail Valley Medical Center is for Project RED (RED stands for "Re-Engineered Discharge"), which started Monday.

"It's to help patients stay at home after they are discharged from the hospital," Creek said. "Phase one is making phone calls to the people who have been discharged and reporting back to the hospital."

Robinson said Project RED is a proactive step to prepare for new health care laws that won't allow hospitals to be reimbursed for patients who are re-admitted within 30 days of discharge.

The Eagle County School District's partnership with Community Paramedics is geared to help students with chronic conditions such as asthma.

"We're bridging the gap between health provider and school," Creek said. "We're making sure the kids are managing their medications at home and school, that kind of thing."

District Director of Student Services Mike Gass said Community Paramedics are a great resource for the school district.

"By helping our students get health care support, they minimize the negative impact that illness and injury can have on their success," he said.

Dan Dougherty, the school district's director of communications, pointed out that in the fall of 2011, 41.9 percent of Eagle County Schools students qualified for free and reduced lunches. He said that indicates they are financially disadvantaged.

"When these children get sick, they may experience longer absences due to poor or lacking health care," he said. "Illnesses plus absences can affect their overall success in school. When the community creates supports for these children, like the Community Paramedics program, then these children miss less school and achieve more success. This is a more wholistic approach to both education and health care - we meet the student's needs wherever we can to ensure that they can have a healthy, successful life."

Eagle County Health and Human Services have partnered with Community Paramedics since the beginning.

"The program has filled in a hole," said Holly Kasper, manager of the Adult Protection Unit. "They add a medical perspective. Sometimes they go with us (on a case visit) and sometimes they're used as an ongoing resource, where we just confer with them."

"(Creek) has a good way of working with people," Kasper added.

Community Paramedics helped with 13 cases last year.

"The more eyes you have on a homebound adult the better," Kasper said. "It's nice to feel we have somewhere else to turn for help with these clients."

Montera said that North Central EMS Institute in Minnesota initially came up with the curriculum that CMC is using.

"Our CP models have grown in lock step," he said. "We've taken best practices from them and they from us."

CMC started with North Central's curriculum in its second version and is currently teaching the fourth version, which is likely to be ironed out a little more.

"We learned the content was outstanding but we'll make the class size smaller in the future," said Robinson, who also works with North Central. "It's hard to manage 100 students in a web-based class."

Patients face no additional costs for CP visits except for services such as vaccines or the lab fees for blood tests. For example, a flu shot would cost about $20 at a hospital. Through the CP program, the administration fee would be waived and the patient would only pay for the cost of the vaccine, which is about $10.

"The Community Paramedic service is free of charge (for the patients) but it is not free - there is a cost to it," Montera said.

The CP program is currently funded by grants that expire at the end of this year. The ultimate goal is to become a recognized provider by insurance companies who will reimburse the program for its services.

"The work is hard to get there - there is a lot more leg work than I thought - but we have data now," Montera said.

In fact, the data from this CP program helped Minnesota pass legislation last year to get its program reimbursed by Medicaid.

"They used our data to get legislation passed and we're using their legislation with our data to get legislation passed here," Montera said.

"I'm in a meeting with the Colorado Department of Public Health and Environment right now," he said Monday.

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The VailDaily Updated Feb 13, 2013 01:56PM Published Feb 13, 2013 01:36PM Copyright 2013 The VailDaily. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.