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Filling health care’s gaps

EVE Community Paramedics 1 DT 7-22-11

GYPSUM, Colorado – Eagle County is leading the U.S. health care system into the future.

As of June 1, Western Eagle County Ambulance District’s Community Paramedics program is the first of its kind in the country and one of only a few in the world.

In a nutshell, the program is intended to be an extension of primary medical care. After receiving doctor referrals, specially trained paramedics can now visit patients at their homes.

The goal is preventative care. Tasks for community paramedics include taking vital signs, drawing blood, giving shots, changing bandages and – perhaps most importantly – keeping tabs on how patients are caring for themselves at home.

“We are an extension of the physician,” said Kevin Creek, one of the county’s two community paramedics. “A doctor doesn’t see how a patient is at home, but we do.”

Creek writes a detailed report for every visit he makes. He observes patients’ health habits, such as how they appear to be eating, and does home safety checks.

“Making sure the home is fall-proof is a big one for the elderly,” he said.

Lisa Ward, the Community Paramedics coordinator, said that in a recent case, a baby was not eating properly and needed to be weighed. The baby’s parents had no transportation to go to a doctor. A community paramedic came to them after a doctor’s referral.

WECAD Chief Chris Montera said two goals of the Community Paramedics program are to reduce hospital readmission rates by 50 percent and to insure all patients who have a “medical home” (primary care physician).

The other three “program measures” are calculating cost savings of the Community Paramedics program versus the cost of ongoing care/hospital care; injury prevention versus potential costs associated with no prevention; and calculating the number of vaccinations given and public health visits.

Ward stressed that the program is not a substitute for primary medical care and that patients receiving the service must be referred by a doctor.

“This is preventative, not primary care,” she said.

Montera said the program was designed with the “sub-acute, semi-chronic patient” in mind.

“How can we get them to the next level to take care of themselves or get more help?” he said. “How do we get care to rural areas that don’t have service?”

That is the mission of the Community Paramedics program.

“We’re filling in the gaps of health care,” Montera said.

So who pays for the service? That question is still being answered in the Community Paramedics’ one-year trial period. Patients face no additional costs for Community Paramedics 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 Community Paramedics program, the administration fee would be waived and the patient would only pay for the cost of the vaccine, which is about $10. For blood samples, the patient would only pay for processing.

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

For now, about $700,000 in grant money keeps the program going. The grants came from Caring for Colorado, the Colorado Health Foundation and the state health department. Meanwhile, independent researchers are tracking the program’s statistics.

“Our job during this trial period is to prove to the insurance companies that the program works and is worthwhile,” Ward said.

Montera said he has been working with Medicare and Medicaid in particular to research long-term funding for the program.

The community paramedics go through intensive training. In addition to their paramedic certifications, they complete approximately 300 hours of clinicals related to home health care.

Eagle County’s program has two community paramedics who use their own vehicles to make house calls. A doctor contacts Ward to have a community paramedic visit a patient. Ward contacts the patient to set up the appointment, and the paramedic follows through.

Vail Valley Medical Center, Colorado Mountain Medical, Eagle County Public Health and Valley View Hospital in Glenwood Springs have all partnered with Community Paramedics.

“Any physician in those networks can refer patients,” Montera said.

Colorado Mountain College is a partner, as well, which helps with education and training. The community paramedics are dedicated to their duties and are separate from the Western Eagle County Ambulance District’s ambulance service, which remains fully staffed.

“Although I have the training, I don’t have an ambulance or its equipment at my disposal,” Creek said. “I might recognize in advance that a patient needs an ambulance and facilitate a response but (the ambulance service) is not what I do.”

The key to getting the Community Paramedics program off the ground was a home health care license issued by the Colorado Health Department. The license is valid for one year as a pilot program. If all goes well, the license may be renewed.

“There are several conditions set for us to follow,” Ward said. “It was a long process to get this started, and we had to get the funding first.”

Montera said the process began in June 2009.

He was at a conference and a speaker spoke about possibilities to improve the health care system and mentioned something like what the Community Paramedics program is now. That got Montera thinking, and he started bringing the idea to the community. The rest is history, and Montera points to a similar program in Nova Scotia.

“Their program has been going 10 years, and they are doing things they probably never dreamed of,” he said.

The country’s health care reform has actually increased the opportunity for programs such as Community Paramedics.

“It was serendipitous that this coincided with health care reform,” Montera said.

That’s because new options are being considered that wouldn’t have been before. Ward said she thinks that all governments, from local to national, are looking for alternatives in health care.

Eagle County is now part of the International Roundtable of Community Paramedics. Other members are from Dubai, Australia, New Zealand and Nova Scotia.

Once a month, the IRCP members and others interested in the program participate in a conference call.

Once a year, there is an international conference, which Vail hosted last year. This year’s conference will be in Australia.

Being the first program in the United States has drawn a lot of attention to Eagle County’s new program.

Ward said they are getting calls all the time from people who want to know how it is working.

“We’re definitely under a microscope,” Creek said.

Of course, there are people who aren’t so sure that the Community Paramedics program is worthwhile. Montera embraces them.

“I’m OK with the skeptics because they keep us on our toes,” he said.