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A proposal to allow establishment of a community paramedic program to help people avoid unnecessary visits to the emergency room was part of House Bill 1410, which was recently deferred by the Legislature.
Why should we worry about this? Because the overuse of the emergency room affects all of us.
For hospitals, the cost of unreimbursed care is growing, and there is no end in sight. For doctors, having on-site help is ideal to address some of the barriers to care that are not visible in a routine visit. For ambulance providers, this offers the opportunity to focus on true emergencies, while other trained professionals work on taking care of the “common callers” who might otherwise be dialing 911.
Finally, for the rest of us, if we have a true emergency there would be more access to immediate care and less waiting if those who had non-urgent needs were taken care of before accessing emergency care.
With everyone as a stakeholder, it’s time to look at ways to pay for such a system.
Hospitals have known about this issue for years. According to the Hawaii Health Information Corporation, the numbers of visits of homeless people to Queen’s Medical Center in 2016 was 11,000, up from 10,000 the year before. That’s just one of our local emergency rooms; many others in the state that face similar challenges.
The cost of these visits is paid by everyone, either through taxpayer-funded Medicaid or through higher health care costs for insurance companies that in turn increase their premiums. There is very little incentive to avoid going to the emergency room, and everyone who goes receives care, regardless of ability to pay. But many visits are not for emergency care, but for minor ailments or even prescription refills.
The overarching goal is to provide the essentials that patients need so that they don’t choose to call 911 for non-emergencies.
Community paramedics might just be the answer, especially for people who are identified as high utilizers of emergency services. Paramedics could be taught the skills they need to do on-site care, whether that be in a private home, at the local park or even on the street.
The overarching goal is to provide the essentials that patients need so that they don’t choose to call 911 for non-emergencies. In some cases, what’s needed might be wound care, and by changing a dressing, infections can be prevented, which helps the person to heal faster instead of getting worse.
Currently, many hospital patients are found to have advanced medical problems that could have been avoided if properly addressed earlier in the course of their illness.
Several cities on the mainland have already started community paramedic programs and have seen surprising results. In San Diego, after many years of watching frequent callers get transported to the ER, an emergency room doctor worked with local fire and ambulance providers to establish a system that led to the Resource Access Program. This enables coordinated efforts of the various first responders to share data and help provide the necessary care to help reduce overall costs. The efforts have expanded to include mental health and social services.
In Fort Worth, Texas, another community paramedic program reduced the calls for non-emergency care by providing home visits. In the neighboring city of McKinney, officials found that not only were emergency rooms sources of referrals for the program, but doctors’ offices also began to participate and request scheduled visits for patients who were at risk, combining efforts to help keep people well and at home.
The old style of house calls may not be the most efficient way for doctors to spend their time, given the hours spent traveling from one house to the next, but with the ever-increasing demand for more convenient methods of care, community paramedics might just be able to fill the need of the most vulnerable in our society.
Not only can 911 calls be limited to true emergencies, but also the team approach to care can help keep people from getting so sick that they need hospital services. Paramedics and other first responders are often the ones who know the frequent callers, and can work together to assist with some of their basic needs.
The Legislature may not have the money to fund such a program, but looking at the dollar expense for the hospitals and increased costs to the health care system, this could be funded privately from the health insurance companies or the emergency rooms themselves.
Given the estimate of unreimbursed care at just our local trauma center, Queen’s Hospital, this could potentially save millions of dollars.
Although it will cost money to provide the necessary training and supplies that will be needed, investments made now would save money later, and possibly lessen the waiting time in our local ERs for those who truly need emergency care.