Video. Mesa Fire and Medical Department

Transcription

1 Video Mesa Fire and Medical Department

2 Establishing a Fire-Based Community Healthcare Program The Mesa Experience Fire Chief Harry Beck Mesa Fire and Medical Department Gary A. Smith, MD Medical Director, Mesa Fire and Medical Department

3 Purpose Describe a model of Fire-Based Community Healthcare for proven performance and efficiencies.

4 Mesa Fire and Medical Department All Hazard Response 21 ALS Engines 5 ALS Ladders 3 Community Care Specialist Units 3 Community Care Units 20 Fire Stations 56,506 Total Calls 80 % Fire Based EMS

5 Mesa Fire and Medical Department Paramedic Capabilities NPPV (BiPAPtm) & Invasive Mechanical Ventilation Continuous Chest Compressions (CCC) Toxicology Trained Diagnostic 12-Lead EKG Rapid Sequence Intubation Traumatic Brain Injury Management Hypothermic IV Therapy Cardiac Alert (Cath Lab) Stroke Alert (CT)

6 Fire vs EMS Calls EMS Fire In 2014, MFMD responded to 1,083 fires and 45,832 EMS calls.

7 Political Challenges New Mayor and 3 Councilmembers Innovation platform New City Manager The Great Recession Conservative political environment Perception of traditionalism Healthcare Stakeholder concerns

8 Labor/Management Unrecognized Union Emerging political influence Strong Labor/Fire Management Relations Open communications and trust Collaboration for service quality and safety Pride of profession Concerns about maintaining staffing levels

9 Video Labor Management Support

10 Labor/Management Leadership Build Community Relationships and Support Network Educate City Management and Elected Officials Establish Team Orientation Establish a Culture of Quality Promote Expertise and Professionalism

11 Labor/Management Leadership Commit to Strategic Vision Declare Value to the Community Update Mission and Brand Market Accomplishments Data Driven Decision Making Over Communicate

12 Evolving Issues National Health Care Major Issue Cost of Health Care % GDP 2020 Health Care - 20+% GDP Impact of Affordable Care Act Resulting Changes to CMS Accountable Care Organizations CMS Innovation Opportunity

13 Community Healthcare Initiative

14 Transitional Response Vehicle (TRV) 2007 Staffed with a Captain Paramedic & FF EMT Reduce The Cost of Response to BLS Calls Keep ALS Units Available Peak Time Deployment Priority Dispatch Triage Physician Assistant TRV Pilot (2008)

15 Community Care Unit (CCU) 2012 Captain Paramedic & Advanced Practiced Providers or Behavioral Health Specialist Treat & Refer to PCP & Appropriate Care Providers Provide Alternative Destination Improved Service Levels - 24 Hour Patient Follow-Up CLIA Waived Laboratory Tests Sustainability - Cost Recovery Provide Support to Law Enforcement

16 Video Paramedic Captain Insight

17 Behavioral Health Patients 30% of EMS Calls Involve Behavioral Health Issues

18 Community Care Specialist (CCS) Captain Paramedic & licensed Crisis Counselor Provide support to Law Enforcement Medical and Mental Health field evaluation Transport to most appropriate destination Connecting to community resources Counselor assessment may allow patient to remain home with a safety and follow-up plan

19 Community Care Specialist (CCS) Coordinate with PD Partnership with Behavioral Health Provider Alternate Destination Transports Significant Improvement in Service Quality Dispatch to Disposition 90 Minutes Considerable Cost Savings

20 Not to replace the Primary Care Physician

21 CMS Innovation Grant Medical care systems integration CCU and CCS Nurse Triage Centralized Medical Control Electronic Medical Record Billing Data analysis and trending Hospital < 72 hour follow-up Education opportunities

22 Performance Measures Medical Care Systems Integration Partner with private providers CCU and CCS Improve patient care and satisfaction Improve fire and EMS availability Reduce transports to ED Nurse Triage Identify low acuity patients Treat via telemedicine and refer

23 Performance Measures Fire-Based Centralized Medical Control 24/7 MD availability Electronic Medical Record Access to patient records Expedite patient care Billing Establish CMS billing codes Establish cost recovery from payers

24 Performance Measures Data analysis and trending Provide cost comparison data Patient follow-up < 72 hour after discharge Reduce 30 day readmissions Medication reconciliation Educational Opportunities Improve overall patient health & safety Provide education of health care alternatives

25 Emergency Care Charges 2014 Low Acuity Patient Transport to ER $1,000 Registration $525 Physician Assessment $325 Decision Making $950 Behavioral Health Patient Transport to ER $1,000 Initial Evaluation $3,500 Three Day ER Hold ($2000/day) $6,000 Inter-facility Transport $1,000 Average Per Patient Total $2,800* Average Per Patient Total $11,500* * Reimbursement rates will vary by region and insurance coverage.

26 Cost Human Resource (Captain Paramedic and Nurse Practitioner or Behavioral Specialist) $310 Supplies/Equipment $20 Response Apparatus $45 Average Per Patient Total $375

27 Projected Cost vs. Benefit Detail 2014 MEDICAL BEHAVIORAL TOTAL Call Volume 2,234 1,489 3,723 Historical Payments $3,126,959 $8,561,911 $11,688,870 Cost Avoidance $1,250,784 $3,424,764 $4,675,548 Mesa FD Costs $837,578 $558,386 $1,395,964 Realized Savings $413,205 $2,866,379 $3,279,584

28 Emergency Room Costs 2013 Source: Kliff,S. An Average Emergency Department Visit Costs More Than an Average Month s Rent. The Washington Post. 2 March 2013

29 Community Care Unit Insurance Coverage 2015 Medicare 24% Medicaid 46% Private 21% None 9%

30 Community Care Specialty Insurance Coverage 2013 Medicare 44% Medicaid 36% Private 19% None 1%

31 Mesa Fire and Medical Dispatch Analysis EMS Calls 43,556 48,267 Low Acuity Calls 12,165 14,329

32 Following Paramedic Assessment 2014 Service Level Dispatch Final Disposition ALS BLS 70.3 % 29.5% 29.7 % 70.5 %

33 Quality Outcomes Improve availability of Engines and Ladders Stabilize or improve emergency response times Improve care to low-acuity patients Implement improved patient triage system Reduce cost of service to low-acuity patients Contract with private providers Improve access to network of existing service providers Improve availability of ambulances Reduce over crowding at Emergency Departments Develop cost recovery for sustainability

34 Community Healthcare Program Operational Needs 2015 Integrate Into the Public Health System Cost Recovery Shared Savings - Capitation ACO Involvement Sustainability Quality Assurance

35 Community Healthcare Program Operational Needs 2015 Healthcare Information Exchange Determine Demographics Evidenced-Based Research Public-Private Partnerships Communication Center Centralized Medical Control

36 Community Healthcare Program Operational Needs 2015 Nurse Triage On-site Medical Direction Telemedicine/Telehealth Public School Partnerships Advanced Education and Licensing for Fire Fighters

37 Community Healthcare Program Service Integration 2015 Enhanced Public Access Fire Station Based Clinics Post-Surgical In-Home Evaluations Post-Discharge, 72hr Patient Follow-Up Court Ordered Behavioral Pickups

38 Community Healthcare Program Service Integration 2015 Frequent Caller Management 24/7 Dialysis Destination Field X-Ray Service Immunization Programs Patient Self-Help, Referral and Follow Ups

39 Community Healthcare Program Service Integration 2015 Hospice Pharmaceutical Support SMI Pharmaceutical Support Community-Based EMS Support (ABCs) EMS and Injury Prevention Support Special Events

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41 Current Events

42 It s Your Move Tradition and Culture Hold on to Communication Center Private sector positioning for EMS DO SOMETHING!!!

43 Disclaimer The project described was supported by Grant Number 1C1CMS from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies.

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