Community Paramedic Programs

[CharlotteGriffin]

We have quite a few folks that need to be reminded to take their meds...

Omg, medication compliance is huge! I see so many people end up back in the hospital because of difficulty with their meds. Very good thing for community paramedicine to do.

 

[Tigger]

Sort of. Most counties when public health nursing started provided case management services for everyone in the county. Funding dried up so now it’s mostly grants tied to specific populations for case management services or hospital funding for case management services to prevent readmissions.

I don’t see how community paramedicine will survive without a funding source. Are there any insurances which will allow you to bill for community paramedic services?

otherwise it’s going to run into the same problems with funding that public health nursing did

Nobody wants to fund public health for the whole community. Sure they’ll find the funds for specific populations but I haven’t seen anywhere in the United States which focuses on the promotion of public health for the entire county and not a subset

CMS will reimburse through its ET3 program while BCBS and Aetna are “soon” to allow for payment for care at home.

 

[FiremanMike]

CMS will reimburse through its ET3 program while BCBS and Aetna are “soon” to allow for payment for care at home.

Can you PM me with details on this? Our billing company has not found any way to bill for non transports in our state..

 

[Tigger]

This is CMS’s ET3 program website for those interested. https://innovation.cms.gov/innovation-models/et3
It’s open to anyone enrolled as a Medicare provider, which is nearly every ambulance provider. I am no longer formally involved in the MIH program at my PRN job so I’m not that helpful. I assisted writing the application which was alright and now to my knowledge the billing is working like it should.

I can’t find info regarding private insurance online, I gotta drop a line into that job to see how that’s progressing.

 

[NomadicMedic]

The ET3 program is not currently open to new services, but your agency leadership should closely watch the CMS website for the next application period if they decide to apply.

Emergency Triage, Treat, and Transport (ET3) Model | CMS

Emergency Triage, Treat, and Transport (ET3) was a voluntary, five-year payment model that provided greater flexibility to ambulance care teams to address emergency health care needs of Medicare Fee-for-Service (FFS) beneficiaries following a 911 call. CMS continued to pay to transport a...

innovation.cms.gov

 

[Summit]

Sort of. Most counties when public health nursing started provided case management services for everyone in the county. Funding dried up so now it’s mostly grants tied to specific populations for case management services or hospital funding for case management services to prevent readmissions.

I don’t see how community paramedicine will survive without a funding source. Are there any insurances which will allow you to bill for community paramedic services?

otherwise it’s going to run into the same problems with funding that public health nursing did

Nobody wants to fund public health for the whole community. Sure they’ll find the funds for specific populations but I haven’t seen anywhere in the United States which focuses on the promotion of public health for the entire county and not a subset

Yes we hate funding preventative care and community health in the US.

And yes, Community Paramedicine exists because nobody wanted to pay for Community Health Nursing and someone said, "hey we could have a weekend class for paramedics and give them a new certificate!!!"

And if it is done right, it is much better than nothing.

 

[supreme]

CMS will reimburse through its ET3 program while BCBS and Aetna are “soon” to allow for payment for care at home.

Very interesting! Definitely something for me to read more about.

Yes we hate funding preventative care and community health in the US.

And yes, Community Paramedicine exists because nobody wanted to pay for Community Health Nursing and someone said, "hey we could have a weekend class for paramedics and give them a new certificate!!!"

And if it is done right, it is much better than nothing.

Hopefully, however the pessimist in me finds it highly unlikely ambulance companies will be able to find motivated paramedics to provide high quality community paramedicine. Ambulance companies are having a hard time enough time finding staff to fill shifts on an ambulance.

I had the opportunity to shadow two different ambulance companies which had been doing community paramedicine for ~5 years. One was doing an amazing job and actually had motivated paramedics. The second was doing community paramedicine because they were forced into doing the initial pilot program because of 1. the geographic location of the community they were in and 2. they were granted the exclusive operating area for the region, there is no other competition for the 911 contract or even IFT due to the usual reasons (reimbursement, low call volume, insurance, etc). Community paramedicine equaled rotating paramedics through on various shifts who would do home visits in between 911 calls or when the call volume was low. There was no quality checks, etc.

 

[Tigger]

Very interesting! Definitely something for me to read more about.


Hopefully, however the pessimist in me finds it highly unlikely ambulance companies will be able to find motivated paramedics to provide high quality community paramedicine. Ambulance companies are having a hard time enough time finding staff to fill shifts on an ambulance.

I had the opportunity to shadow two different ambulance companies which had been doing community paramedicine for ~5 years. One was doing an amazing job and actually had motivated paramedics. The second was doing community paramedicine because they were forced into doing the initial pilot program because of 1. the geographic location of the community they were in and 2. they were granted the exclusive operating area for the region, there is no other competition for the 911 contract or even IFT due to the usual reasons (reimbursement, low call volume, insurance, etc). Community paramedicine equaled rotating paramedics through on various shifts who would do home visits in between 911 calls or when the call volume was low. There was no quality checks, etc.

My old job tried mandating everyone get trained. It’s too much of an additional add for most folks and we shelved that idea once we had generated enough operating revenue through behavioral health response contracts to hire dedicated staff (some internal some external). There is still a struggle with the community paramedics wanting to do some 911 work when they aren’t busy and I think it’s not possible to stamp that out. They do their very best to keep it from interfering with CP duties but at the end of the day most paramedics still wanna paramedic. That said it turned out to be an awesome environment for people who are extremely smart and but motivated but were difficult to reign into the usual EMS command structure. Our CPs work pretty much directly for the physicians and they like that autonomy a lot.

 

[FiremanMike]

My old job tried mandating everyone get trained. It’s too much of an additional add for most folks and we shelved that idea once we had generated enough operating revenue through behavioral health response contracts to hire dedicated staff (some internal some external). There is still a struggle with the community paramedics wanting to do some 911 work when they aren’t busy and I think it’s not possible to stamp that out. They do their very best to keep it from interfering with CP duties but at the end of the day most paramedics still wanna paramedic. That said it turned out to be an awesome environment for people who are extremely smart and but motivated but were difficult to reign into the usual EMS command structure. Our CPs work pretty much directly for the physicians and they like that autonomy a lot.

I share an office with our CP, and I can definitively say that I want NOTHING to do with what he does on a daily basis. And this is coming from someone in nursing school, lol!

 

[supreme]

My old job tried mandating everyone get trained. It’s too much of an additional add for most folks and we shelved that idea once we had generated enough operating revenue through behavioral health response contracts to hire dedicated staff (some internal some external). There is still a struggle with the community paramedics wanting to do some 911 work when they aren’t busy and I think it’s not possible to stamp that out. They do their very best to keep it from interfering with CP duties but at the end of the day most paramedics still wanna paramedic. That said it turned out to be an awesome environment for people who are extremely smart and but motivated but were difficult to reign into the usual EMS command structure. Our CPs work pretty much directly for the physicians and they like that autonomy a lot.

Exactly, most paramedics want to be paramedics and run 911 calls or go onto fire. I doubt many people go into paramedic school with the idea of wanting to do CP or run ALS IFT calls. CP might be a good avenue for someone burnout from 911 who wants to retire in EMS as a paramedic. Requires a completely different mindset and skill set from running 911 calls though.

I share an office with our CP, and I can definitively say that I want NOTHING to do with what he does on a daily basis. And this is coming from someone in nursing school, lol!

This is similar to how most people go into nursing wanting to do acute care. Sure there are other avenues, public health, clinic, clinical trials, etc but the majority want to do acute care. @Tigger

 

[FiremanMike]

This is similar to how most people go into nursing wanting to do acute care. Sure there are other avenues, public health, clinic, clinical trials, etc but the majority want to do acute care. @Tigger

That’s what I set out to do when I started nursing school. Suprisingly, psych has really grabbed me the most. I have switched gears from ACNP as my goal to PMHNP, where I will focus on med management and cognitive behavioral therapy for public safety..