Community Paramedics revisited

ExpatMedic0

ExpatMedic0

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I found these articles interesting.

http://bangordailynews.com/2012/03/...irst-in-maine-community-paramedicine-program/

http://www.jems.com/article/administration-and-leadership/how-affordable-care-act-will-change-ems

http://www.jems.com/article/role-ems-community-paramedicine

The part I liked the most was "Paramedics already holding an associates degree can enroll in the advanced certificate level of the program, which consists of five career courses totaling 16 credits, all but one of which will be offered online. Paramedics who do not have an associates degree will enter the associate in science degree level of the program, taking the same five career courses, as well as an additional 44 credits in math, science and other general education courses."

It may not be much, but its a start in the right direction. Finally a Paramedic with a degree requirement. I think we are going to see a big changes soon with the introduction of the affordable health care act, community paramedicine pilot programs appearing with degree requirements, and the U.S. meeting with Australian community Paramedic leaders, who have a lot of experience in the area and offer a graduate degree in the subject. What do you think?





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DISCLAIMER: You may remember this topic from a month or two ago. Unfortunately that thread was locked due to bickering. To prevent this thread from being locked and staying on topic, I would appreciate we keep the conversation on topic which is "Community Paramedicine." If anyone wishes to discuss community Nursing in the pre-hospital environment, or other types/levels of providers who provide public health services, please start your own thread. Also, please no degrading any health care professions inside or outside EMS. We are here to discuss Community Paramedicine and show respect for each other.
 
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ExpatMedic0 said:
It may not be much, but its a start in the right direction. Finally a Paramedic with a degree requirement. [/B]
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Amen.

Community healthcare is the future, regardless of the exact profession in allied health. With the ACA the emphasis will be removed from individual outcomes to affordable population care. Paramedics already have in infrastructure and logistical ability to deliver care effectively to a large population.

One of the areas I have found that we do not do a good job advocating for our patients is in the area of nutrition, psychiatry, and preventative care. Additional training and scope of practice is a much needed advance for the American EMS system.
 
azemtb255 said:
Amen.

Community healthcare is the future, regardless of the exact profession in allied health. With the ACA the emphasis will be removed from individual outcomes to affordable population care. Paramedics already have in infrastructure and logistical ability to deliver care effectively to a large population.

One of the areas I have found that we do not do a good job advocating for our patients is in the area of nutrition, psychiatry, and preventative care. Additional training and scope of practice is a much needed advance for the American EMS system.
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Don't get me wrong, I think community healthcare, specifically community paramedicine is a great idea. A lot of money can be made and put where it counts (education, 911 response, actual emergencies, etc). Plus that extra education in basic pathologies and conditions can make a medic even better than before. More opportunities for prehospital providers.

However it got me thinking. I feel like this is similar to the physician vs midlevel provider debate currently raging in medicine. People would fight about our level of training and the variety of procedures we are allowed to perform etc. It also gives the patient (at least I think somewhat) the idea that, "Well, hey. If medic Jerry said I should be okay why should I go visit my doctor anymore? I'm just throwing away money with that $300 a visit charge." It gives them a reason to stay away from definitive care when perhaps maybe they really do need it, but stay at home at receive supplementary care.

Maybe I have a wrong interpretation of the community paramedic, and the role they provide, but wouldn't you agree? I'm curious to see what other people think.
 
Unfortunately, community health is mostly only considered as a stopgap measure; good for rural populations where we can't schlep everyone into a physician's office or the ED, but automatically inferior to doing that instead. I've had some great interactions with Boston Medical Center's community midlevels, mostly with medically complex poor patients. It's nice to have a health program that isn't dependent entirely on patients taking the initiative. Homebound elderly are the other big population for this, and I suspect a lot of people here have carried someone out of their house and spent an hour with them for their 15-minute physician appointment.

In deference to the OP, I'll pass over the relative merits of community paramedicine. It doesn't matter much anyway, because there's going to be massive resistance to urban community health from physicians, hospitals, and payer inertia.
 
Anyone have any speculation if they think this is something the NREMT could adopt? If they did adopt a community paramedic level, would implementing such a new level pave the way for national degree requirements?
 
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ExpatMedic0 said:
Anyone have any speculation if they think this is something the NREMT could adopt? If they did adopt a community paramedic level, would implementing such a new level pave the way for national degree requirements?
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The skills needed for community/primary care paramedics are much more educational based and can vary from state to state depending on enabling statutes and other requirements.

Until there is a national standard for this level NREMT would just be blowing in the wind as it would be hard to test to a standard that is not there.

With that siad I'm sure they would be excited to do it as it will open a new revenue stream with written and psychomotor testing and a new spiffy patch with nominals for your name that will not be worth much to anyone.

I think that a stand alone community paramedic compatency exam, ala FP-C or CCP would make more sense.

As for the education needed, more is almost always better, but we need to hit the happy median between degreed PA/RN providers and field paramedics operating on the fringe of primary care in some fashion. I think this will be an exciting growth area for prehospital care and am looking forward to seeing more.
 
ExpatMedic0 said:
Anyone have any speculation if they think this is something the NREMT could adopt? If they did adopt a community paramedic level, would implementing such a new level pave the way for national degree requirements?
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I think it would be great if the NR adopted a community medic cert - even better if they created a new level that required a BS and included a slightly more advanced skill set similar to what we see in Europe.

but I doubt this will ever happen....and if it does....it will not be soon.
large organizations move slowly and are scared to innovate and try new things. Old dogs, new tricks.
 
How would a Community Paramedic be distinguished from a visiting nurse?
Not trolling. I seriously am not sure!
 
azemtb255 said:
I think it would be great if the NR adopted a community medic cert - even better if they created a new level that required a BS and included a slightly more advanced skill set similar to what we see in Europe.

but I doubt this will ever happen....and if it does....it will not be soon.
large organizations move slowly and are scared to innovate and try new things. Old dogs, new tricks.
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That would be pretty awesome, but I agree with your assesment. If we see a national stabdard BS level medic in my lifetime, I'll be surprised (but happy).

Simusid said:
How would a Community Paramedic be distinguished from a visiting nurse?
Not trolling. I seriously am not sure!
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Shhhh! We can't talk about Community Health BSN RNs in this thread or there might be some uncomfortable questoins and debates. The purpose of this thread is discuss this idea of community medics in a vaccum so that it doesn't have to stand up to scrutiny. ;):unsure::glare::sad:
 
Summit said:
Shhhh! We can't talk about Community Health BSN RNs in this thread or there might be some uncomfortable questoins and debates. The purpose of this thread is discuss this idea of community medics in a vaccum so that it doesn't have to stand up to scrutiny. ;):unsure::glare::sad:
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The biggest difference in community paramedicne vs BSN/RN community health is the access through the 911 system. While our nurses are making thier scheduled rounds, the paramedcis could respond to sub-acute situations as determined my triage protocols and either treat and release or other interventions including transport (arranged or actual) to non ED providers. RN and medic SHOULD be working together, not at odds with each other.

Community medicine and health care as a whole needs to evolve, I think there is a place for both the community paramedic and the community RN both helping to keep folks who don't need it out of the ED, as well as prehaps prevent some people from ending up in an ED from non-compliance or lack of entry in the system except via ED/911.
 
Yes, I think one reason this whole concept is beginning to boil to the surface in the USA is because there is now a way to profit from it and it has already been used and proved successful in other countries. I have posted community paramedic studies on here in the past, they show %80 reduction in ER admission.
3 reasons off the top of my head are below

1. The way EMS is being reimburse is changing dramatically with the PPACA.
(see interesting article hereIt will also lead to EMS "checking up" on frequent fliers and recent discharges.

2. It has already increased Paramedic education. Although Community Paramedcine pilot programs really just started in most areas, Maine has already made it a degree requirement, other state's programs are requiring additional college course work, and its not long before everyone follows suit. Community Paramedicine has advanced education for EMS providers in some states more in a few months than decades of standard U.S. EMS education to date. It is gaining momentum at an alarming rate right now because of the PPACA and other factors that are new, that will increase profits and demands from EMS agency's. If we(EMS) do not move fast enough and do this the right way, we could lose it as an opportunity.

3. The old way our EMS system works is, if someone ask to go the hospital you have to take them... My friend once took a guy for playing to much xbox because his hand hurt. However... I am thinking with the introduction of this paramedic model, frequent fliers and unnecessary ER admissions would be eliminated, as shown in the study where ER admissions where reduced by %80 because of community Paramedics. We are already responding to these people, they are the majority of our calls and patient, we are already going to there house with all are resources and equipment, now we can just treat and release in some instances. Which is what Paramedics do in most other countries anyway.
 
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I am currently laying the foundation for a program in my area.

This is the future and it will be a reality. For anyone who questions who will pay for it or why...here is the reason.

Reimbursements to hospitals has changed. If they admit a patient 3 x in a 30 day period for a chronic condition, they will no longer be paid for the 2nd visit. There is huge loss of revenue when you extrapolate those numbers.

Collectively, hospitals will love this approach and will help pay for it. The reimbursement system is changing and holding the hospitals accountable for their treatments.

Ideally, a community paramedic is a better approach in the sense that studies have shown repeatedly just visiting your chronic illness patients reduces 911 calls. In our study just being finalized, we excluded drug and alcohol abusers and psych as those are an entirely different issue right now. We focused on diabetics, CHF, HTN, etc...when you visit these people and are educated enough to review their systems and medications, therapies, and perform a basic health screen you will see a positive impact in the sense that 911 call volume goes down, admissions go down and overall patient pro-activeness in their health care improves.

Another benefit aside from reducing strain on area hospitals is it reduces strain on area emergency response systems as well. The IAFF may protest this but we have to not be selfish and wonder what is in it for us, but what is better for humanity. Definitely a shift away from traditional American thought.

With a robust enough program, you may see a truck or two being taken off the streets and those funds being allocated to the Community program. No one likes working themselves out of a job but it is time and necessary.

Typically the paramedic is embedded, he/she has already met or transported these patients. This is how they get on the list for community health checks. Visiting nurses are visiting those who are already in the system one way or another. By utilizing a paramedic or having an in house referral system, in theory there could be no delay in visiting someone. Crew A sees a patient for hypoglycemia today, submits a form and Community Medic B puts them on his list to visit tomorrow. Bam...they are now in the system. The other processes typically take a lot of time and bureaucracy and typically follow repeated hospital admissions, etc.

Would this program eventually grow and become just as cumbersome with paperwork and admission into the system? Possibly but at least we are thinking about it now and trying to find ways to prevent that and keep it to its true form.

Lots more to discuss but thats the overview.
 
Our pilot program (a version of community paramedicine) has actually been met with alot of resistance from hospitals because of the reduction in ER admissions.

Hopefully, once they've sorted out the reimbursement issues for ACOs, this resistance will change as continuity of care and prevention of hospital admissions will have more focus and affect reimbursement. Should start seeing some effects from the up and coming hospital re-admission penalties soon as well.

It will make for interesting times.
 
This is all fine and dandy, but until we see an increase in all of our salaries equivalent to our education. This topic is dead in the water.

The few people who will do it regardless of money are worth their weight in gold. But if I were to jump on this bandwagon and obtain my BS in order to do so, there better be a bump in pay. Because honestly, I didn't get a single cent more for me going and getting my CCEMT-P.

The moment I see the program running requiring the BS or equivalent with salaries comparable to the amount of education. I will jump on it.

But this will have a lot of hurdles to overcome. As this program was originally intended for rural areas without immediate access to definitive care. And majority of those areas still rely on volunteers. Not knocking them. But it's time to wake up and smell the roses. Pay has got to come in line with required education levels.

Otherwise, This is the future of EMS.
 
Action942Jackson said:
This is all fine and dandy, but until we see an increase in all of our salaries equivalent to our education. This topic is dead in the water.
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Wait.... So are you advocating we need to be paid less? Because our education is laughable... There are many medics that are far overpaid for the education they posses... :unsure:
 
PoeticInjustice said:
Wait.... So are you advocating we need to be paid less? Because our education is laughable... There are many medics that are far overpaid for the education they posses... :unsure:
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No, what I am saying is if there is going to be another career path for the career medic (CP) requiring higher education. Then salaries should be risen to fully compensate based on amount of education for that particular path.
 
Action942Jackson said:
This is all fine and dandy, but until we see an increase in all of our salaries equivalent to our education. This topic is dead in the water.
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Sorry bubba, that's not how it works. Prove you can rise to that level then we'll talk about pay.

I spent a fair amount of my own money on CCT education. It didn't pay off immediately but I now have the job I do because of it. To take the next step I'll need to get a BS, which will also be out of my pocket...but it'll lead to much greater opportunity.
 
usalsfyre said:
Sorry bubba, that's not how it works. Prove you can rise to that level then we'll talk about pay.

I spent a fair amount of my own money on CCT education. It didn't pay off immediately but I now have the job I do because of it. To take the next step I'll need to get a BS, which will also be out of my pocket...but it'll lead to much greater opportunity.
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To whom do you request I prove "my level" to? What level do you speak of? Paragod v. 4.0? :p I think you missed the gist of my stuff. What I was specifically referring to was if this next level of paramedic required a BS degree, it better come with a bump in pay. There's no way in hell Im paying out the wazoo for BS degree nowadays to get to another level of paramedic with no additional monetary compensation. I make 37k a year as a medic right now. 9 years in EMS, 7 as a medic. Ive learned since I paid for my own CCEMT-P, to not do that again. Do you see doctors choosing another specialty for free or no change in pay? Nope.
 
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