Community Paramedicine (CP) is an evolving model of community-based health care in which paramedics function outside their customary emergency response and transport roles in ways that facilitate more appropriate use of emergency care resources and/or enhance access to primary care for medically underserved populations. Several countries and states around the U.S., including North Carolina, Colorado, Minnesota, Maine, and Texas, have implemented variations of Community Paramedicine. Every state has implemented a CP model that works best for them. Taking a closer look at how Maine implemented their CP program across the state provides examples of best practices and the role of the State Office of Rural Health (SORH).
Timeline to Successful Implementation of a Statewide Community Paramedicine Program
2004 – The publication of Rural and Frontier Emergency Medical Services: Agenda for the Future by Kevin McGinnis encouraged Maine EMS to explore the concept of CP further to see how rural EMS could be used in ways other than 911 calls and interfacility transfers with the ultimate goal to fill an unmet healthcare need.
2009/10 – Maine EMS hired Kevin McGinnis as the Community Paramedicine Pilot Project Coordinator to help design a statewide program for both large and small services that included input from all healthcare providers.
Maine EMS extended an open invitation to an information session on Community Paramedicine. Panelists included: Kevin McGinnis (ME), Gary Wingrove (MN), Anne Montera, RN (CO) and Mike Wilcox, MD (MN) Those attending the session included EMS providers, emergency department physicians, primary care physicians, hospital and home health nurses, hospital administrators, PAs, NPs, MaineCare (Medicaid) and 3rd party insurance providers, SORH, and many others totaling over 70 participants. From this meeting, two groups formed – a Task Force and a Steering Committee composed of essential healthcare leaders.
The CP Steering Committee took the concept discussed by stakeholders, refined the process, and developed the application process:
2011 – The Attorney General after researching state and federal enabling legislation, provided an opinion that the Maine EMS statute did not include the authority to approve CP pilot projects. Maine EMS met with the Governor’s office to discuss submitting a bill to the legislature, which was received unanimous support at the public hearing and on the floor of the House and Senate.
2012 – Maine EMS released applications for pilot projects.
Applicants were required to:
- Assess the culture of the EMS service/personnel, and take their own pulse (to identify support for CP)
- Identify others in their community involved in healthcare to collectively determine what the unmet healthcare needs are in the community.
- Submit proposal to Maine EMS that explains the community determination process, who the partners are, identify both a PCP medical director and an EMS medical director, Proposal must also include training, quality improvement, and data collection plans.
2013 – The Steering Committee approved 13 pilot applications, resulting in 12 pilot projects
Activities in 2013 and 2014 focused on four key areas:
- Providing technical support for Community Paramedicine pilot project proposals
- Providing education for EMS services and other allied health care providers, including: Patient Centered Medical Home clinics, Community Care Teams, and Critical Access Hospital Quality Managers.
- Working with the University of Maine, Muskie School, to design the data collection criteria and performance metrics.
- Convening a regular forum for Community Paramedicine administrators to share lessons learned, best practices, and ideas for assessment and improvement.
Since May 2013, EMS providers have conducted 1,500 home visits. Patient treatment typically includes post-discharge visits for chronic illnesses such as congestive heart failure, chronic obstructive pulmonary disease, and diabetes. Depending upon the EMS provider’s license level, these visits may also include flu vaccination, drawing blood and specimen collection. Other typical care includes: home safety and wellness checks, fall prevention, and medication reconciliation.
There is currently no mechanism for reimbursement; however, with the data evaluation of the program will hopefully identify possible codes that can be used to satisfy CMS. This analysis will also look at developing performance measure, cost savings, and customer satisfaction.
The Role of the SORH
The relationship between the Maine SORH and Maine EMS is exemplary and based on frequent communication. The SORH has a complete understanding that EMS is an essential component of the patient centered medical neighborhood. In addition to other state EMS initiatives including onsite hospital visits from the Trauma Advisory Team, the Maine SORH used Flex funds to support the administration of the CP Program. However, support goes beyond strictly financial. The Maine SORH was involved in every step along the way from development of the program, support of legislative action and approval of pilot applicants. The partnership between the two organizations has fostered an environment of success.
If your state is interested in implementing a Community Paramedicine program, consider discussing the evolution of the program in Maine with Jay Bradshaw, Maine EMS at firstname.lastname@example.org and Matt Chandler from the Maine SORH at email@example.com.
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