April 5, 2019
The University of California San Francisco has released its latest evaluation of the community paramedicine pilot program. The report, produced by Dr. Janet Coffman at the Philip R. Lee Institute for Health Policy Studies, analyzed California community paramedicine through September 2018 and echoes previous reporting which has shown the pilot to be both effective and safe in its effort to reduce health care costs and extend care into at-risk populations.
Since 2014, a California Healthcare Workforce Pilot Program (HWPP) has studied new, innovative models of EMS that put paramedics in preventative roles and work to reduce unnecessary or inefficient health care. The pilot has explored areas such as post-discharge follow-up, frequent EMS users, tuberculosis management, hospice care, and alternate destination strategies for 911 callers. These diverse areas of programming have been grouped together in what is now called community paramedicine. Thus far, more than 4,300 Californians have been treated by community paramedic programs across 18 locations from San Diego to Northern California.
The recently released review serves to bolster arguments in favor of widespread community paramedic programming. Patient safety concerns in programs that divert patients away from emergency departments, a frequent concern of critics, seems to be assuaged by UCSF’s analysis showing that 1200 alcohol intoxicated patients diverted to sobering centers in San Francisco were triaged with 97.8% accuracy and no safety incidents.
The report showed congruence among other alternate destination programs targeting additional patient populations, such as in the Central Valley where 800 mental health patients were steered directly to behavioral health facilities instead of filtering through emergency departments. Psychiatric patients lacking a medical condition requiring treatment can often skip traditional emergency department assessment and evaluation, thereby saving significant time and money. Many view such programs as a critical component in solutions to overcrowded emergency departments, ballooning healthcare costs, and important behavioral health reform.
Another facet of the UCSF report is the continued success of paramedic integration into complex patient management. In San Diego and San Francisco, community paramedics worked with at-risk populations to drive down their 911-utilization rates for non-medical needs, such as food, housing, and substance abuse. Across other counties, paramedics worked with recently discharged populations to better coordinate post-discharge care plans with the goal of reducing hospital readmission. The report found paramedics were able to reduce utilization and readmission rates, respectively, and with improved outcomes and associated cost-savings.
UCSF’s analysis also shines light on significant challenges which will continue to surface as the paramedic industry shifts its weight. Some programs, despite their documented success, have been limited or shuttered entirely due to lack of resources. However, recent introductions nationally via the Health and Human Services Department and the Centers for Medicare and Medicaid Innovation (CMMI) have shown that reimbursement changes are coming that will eventually provide more support to community paramedicine programs.
Dr. Coffman’s analysis comes at a critical time as EMS stakeholders and legislators work to formalize the community paramedicine pilots, which have already exceeded the traditional time frame of a pilot program. Legislative attempts in Sacramento last Fall became mired down in union and political antics—the resulting bill was ultimately vetoed by then Governor Jerry Brown who asked the stakeholders to produce cleaner language. The authors and sponsors of that legislative attempt have recently reintroduced the bill hoping a new legislative session and Governor may produce different results.
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