Kevin McGinnis MPS, WEMT-P Program Manager Mobile Integrated Healthcare/ Community Paramedicine National Association of State EMS Officials

Transcription

1 Kevin McGinnis MPS, WEMT-P Program Manager Mobile Integrated Healthcare/ Community Paramedicine National Association of State EMS Officials 1

2 2001 Community Paramedicine: Rural Roots Paramedic Paradox The further one moves from an emergency medical facility, The more one may need higher levels of local EMS capability, And the less likely that this EMS capability will be available.

3 Rural Paramedic Paradox Financially Less Supportable Fixed Cost of Paid Crew Availability of Volunteer Paramedics Operationally Less Supportable Skill Retention

4 Rural Health Needs Access to Clinic/Hospital Bound Resources Physicians/PAs/NPs Preventative Care/Chronic Condition Management Support Services (e.g. Home Health, PT/OT, Dietary, Immunizations, Lab, Counseling) Unscheduled Medical Care Minor Interventions Preventative Acute Interventions 4

5 Community Paramedicine Adapting EMS resources to address community health care and/or public health needs not currently being met and embracing the paramedic paradox as one of those needs.

6 1973 -Blueprints for the System of EMS

7 Blueprints for the System of EMS EMS Agenda for the Future (1996) The Vision Emergency medical services (EMS) of the future: Community-based health management Fully integrated with the overall health care system Able to identify and modify illness and injury risks.. Able to provide acute illness and injury care and follow-up, and Able to contribute to treatment of chronic conditions and community health monitoring 7

8 Blueprints for the System of EMS 8

9 2004 : CP already exists in many settings across the country..

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13 Joint National EMS Leadership Forum Survey NAEMT Website

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15 Three Approaches Community Paramedicine Community Paramedic

16 IS Community Paramedicine A generic concept A means to fill a temporary or on-going health care need Expansion of EMS roles and services to assist community health team colleagues Generally on an episodic, not case management, basis IS NOT An expansion of EMS scope of practice Just for the Paramedic license level. The same in every (or any) community Competing for community health roles, but leverages the 24/7 presence and mobility of EMS resources in the community 16

17 Evolving Concept.. Community Paramedic A state licensed Paramedic who is certified as graduating from a recognized college program in community paramedicine and operates within the scope of practice for their licensure level as approved by the state under appropriate medical direction for the nature of their practice. General Practice Episodic Care (e.g. Chinese Menu Approach) 17

18 Curriculum the North Central EMS Institute Community Paramedic. All rights reserved 18

19 7 Curriculum Sections Role in the health care system Social determents of health Role in public health and primary care Cultural competency Role within the community Personal safety, self care, and professional boundaries Clinical care of the population s health gaps

20 3.0 Curriculum Structure Didactic Module Online weeks Group Work Lab Module Peds, Adult, Geriatrics Optional based on population s need 3-5 sessions Clinical Module Select modules based on population s need hours

21 However.. Not Universal Volunteer Svcs. Busy FD Svcs. Will Evolve Only As needed Where needed How needed 21

22 More Recently Mobile Integrated Healthcare (MIH) An array of systematically coordinated, medically directed, evidence-based and performance-measured services and providers deployed in a mobile environment. Provider disciplines deployed depend upon need addressed, and would include community paramedicine providers as a subset.

23 And?

24 Statutory Approaches No/Minor Statutory Changes Delegated Practice No Statutory Change/Current Definitions Work Statutory Changes Needed for Practice and/or Reimbursement Survey As long as within scope of practice

25 NASEMSO CP Member Poll (1) Have you interpreted your EMS enabling statute as allowing community paramedicine (within your scope of EMS practice for those individuals) to be provided in the State? Yes: 17 No: 8 No Interpretation: 12 (2)Have you interpreted your EMS enabling statute as prohibiting community paramedicine (within your scope of practice for those individuals) to be provided in the State? Yes: 2 No: 24 No Interpretation: 11 Yes/No (16) + No/No (6) + Yes/X (1) + X/No (2): 25 (Allow/Don t Prohibit) Yes/No: 2 (Prohibit; CA enabling pilot projects; NY writing enabling leg.) X/X:10 (No Interpretation) (3)Has your enabling statute or regulations been amended to enable or prohibit community paramedicine to be practiced in the State? Yes: 5 No: 32

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27 Currently No Universal Funding Provisions Start-ups: Self-funded; Excess Capacity Grants CMS & Other Third Party Payors: Future: CMMI Grant Program Minnesota: Medicaid Maine/Others: Medicaid No Transport UPMC/Highmark; MedStar Demonstrate Value to: Current Reimbursement Model Payers Evolving ACOs and Medical Home Practices

28 $$$$ CMMI Grant Program 2012 Cites CP as Eligible Concept Awards $13 Million to 3 CP Projects: Upper San Juan Health Service; CO ($1.5 M) Prosser Public Health District; WA ($1.5 M) REMSA; Reno/Sparks; NV ($10 M)

29 Nova Scotia Clinic Model % ED Use Reduction Nursing Home Model 60% ED Transport Reduction 29

30 MedStar Mobile Healthcare - Texas

31 City of Toronto Community Collaboration: Community Referrals by EMS Results: 73.8% reduction in 911 calls from target population (February 2010) 31

32 City of Winnepeg CP in detox facility 52% ambulance reduction $250,000 annual savings (est.) 32

33 Others Colorado - Public Health Nursing Partner Model Pittsburgh EMed Home Health Partner Model San Francisco Frequent Flyer Overutilization Wake County, NC - Redirect to Alternate Destinations Dallas/Fort Worth - MedStar Minnesota Health Bus Portland, Oregon Tulatin Valley Fire and Rescue

34 Medical Direction Primary Care & EMS Mix Flexible Models to Meet Resource Availability Small, Rural Facilities: Single Physician? Medium Facilities: 1 PC & 1 EM/EMS? Health Systems: 1 Physician Coordinating Many? The Balancing Act When is a patient interaction an EMS event? When is a patient interaction a CP event? What happens when an interaction transitions? 34

35 Curriculum the North Central EMS Institute Community Paramedic. All rights reserved 35

36 Version 1.0 in 2009 Minnesota s Pilot Project Phase 1 - Foundational hours Phase 2 - Clinical hours 12 Students 100% classroom setting

37 Version 2.2 in 2010 Colorado s Pilot Project Didactic Module Online 12 weeks Classroom 5 sessions Lab Module Medical Director Clinical Module Phase 1: 100 hours Phase 2: hours

38 Version 2.2 in 2011 & 2012 Minnesota's 2 nd & 3 rd Class Hennepin Technical College

39 Version 3.0 Spring 2012 Pilot 13 States 23 Agencies 107 Students

40 Collaboration: Maine CP Project Maine EMS (DPS) Maine Office of Rural Health (DHHS) Components (Over 3 Years) On-Going Task Force Pilot Project Approach With Uniform: Medical Direction/Quality Improvement Processes Prospective Research Methodology Integration Into Community Health Teams

41 Pilot CP Project Models Community Paramedic Model Licensed Paramedic Hour College-Based Program Primary Care/Emergency Medicine Oversight Integrated in Community Health Team Enabled/Extended Health Services Model Licensed Providers Within Their Scope Limited/Selected Services Additional Training, and Oversight as Appropriate Integrated in Community Health Team

42 Maine Statute Sec MRSA 84, sub- 4 Establishment of community paramedicine pilot projects Effective August 30, 2012: Using the same process for using pilot projects to evaluate the workability and appropriateness of incorporating a particular emergency medical treatment technique or a type of equipment into any licensure level, the board may establish up to 12 pilot projects for the purpose of developing and evaluating a community paramedicine program. A pilot project established pursuant to this subsection may not exceed 3 years in duration.

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44 Questions????? Kevin McGinnis, MPS, Paramedic Program Manager Mobile Integrated Healthcare/Community Paramedicine National Association of State EMS Officials