West Virginia Community Paramedic

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West Virginia EMT – Community Paramedic

EMS history is being made!!!

The West Virginia Community Paramedic is on the horizon, but what does it mean for the future of EMS and the ambulance business?  The New River Community & Technical College announced to our office yesterday that they will host the first program of its type in the state.  The course is open to Paramedics who are already certified.  26 weeks, 5 days per week will be required on the Lewisburg, WV campus.  See the announcement text here…

EMS history is one of humble beginnings. We have a long history of fundraising, bake sales, and donations. But this eventually gave way to “fee-for-service” billing. Science was beginning to tell us that rapid interventions such as early defibrillation could save lives. People were demanding a better level of service from EMS. They could see that some communities had amazing Paramedic programs when they watched television shows like “Emergency”. As a result, insurance programs started paying for the service, the amounts were small at first, but public and private enterprises started to form. Many of the EMS agencies formed are still around today. In those early days, new ambulances and paid Paramedics probably looked like an impossible feat. Costs were always high and billing income was not always reliable. It took determination and guts to open an ambulance business or a rescue squad in those days. EMS was just beginning to come of age, a lot was still unknown. You had to believe that you could find your way into the future.

The EMS industry has been in some stage of evolution from day one. Today we can see the future if we are looking for it. Today’s changes are dramatic, and they make it hard to think about the next five years, the next ten years. But another major shift is on the horizon, and this one may be a lot more dramatic than going to paid crews. A very different EMS service is evolving and coming into focus. New River Community Technical College announced yesterday that they will start classes for the state’s first Community Paramedic program in early 2017.  Someone clearly sees an opportunity here.

Innovation is key… but the Community Paramedic home visit is not covered by most insurance programs, yet. We did find one payer that covers it, but that payer pays very little for the service.  At first this makes very little sense. The CP program is only open to certified Paramedics and the program takes 26 weeks of full time study. This just does not add up…until you begin to look at the various ways CP programs can be funded, then something begins to come into focus.  This author had to read several articles and case studies about Community Paramedicine and Accountable Care Organizations before it all started to make sense.

The Community Paramedic is a fascinating service level, a hybrid of an EMT-P and a Physician Assistant. The CP enters the patient’s home after a major illness to coordinate patient treatment goals and ensure access to any healthcare service that the patient needs. The goal is to give the patient great care in the home and reduce the need for the patient to return to the ER. This heads off major problems before they occur. This approach is having a lot of success with CHF and COPD patients who are newly discharged from a hospital stay. These patients can have a Community Paramedic visit them every day, twice a day if needed. Once the CP provides a thorough assessment the attending physician can be consulted. Labs can be ordered, medications adjusted and picked up, additional therapies and treatment modalities initiated…additional services scheduled…and yes transportation by ambulance can be set up if needed.

The key to this system working is that every provider involved in the patient care process, has already agreed to work together for the purpose of improving care, outcomes and patient satisfaction. They had to sit down at a table and organize themselves into an “accountable care organization”. Medicare can fund these ACO’s with large cash payments, as long as patient care, outcomes and satisfaction improves, the ACO providers get to keep any money left over. This is an entirely new type of healthcare provider and ambulance providers can be a part of this. It sounds like it would be difficult to set something like this up, and it probably is, but when providers organize themselves behind these goals, it seems to work.

The next generation of successful EMS entrepreneurs may be those who can best work together, bringing multiple provider types to the same table. Medicare’s newest prior authorization requirements certainly assume ambulance providers have a close working relationship with referring physicians and facilities. Collaboration between providers will help make sure the patient is getting the care they need at all times, even during an ambulance transport.

The West Virginia EMT – Community Paramedic press release from NRCTC contains details on campus, pricing and contact information…click here.

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Keith A. Waycaster, CEO

 

This chart represents the stages of a community paramedic visit

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