Expanded Role of Paramedics and Expanded Savings in Michigan CP Pilot
Recently, Huron Valley and Livingston County ambulances in Michigan have been picking up extra passengers: community paramedics, prepared to deal with non-emergency situations. The community paramedicine pilot program, which began in August 2015 and is projected to continue for the next 3 years, has met with high patient satisfaction thus far. For non-emergent calls, community paramedics ride along with EMTs and do an assessment of the patient and their environment. After this assessment, with the patient’s agreement, the ambulance crew can be released back into service. The community paramedic can then provide primary care for minor illnesses, schedule follow-up visits or phone calls and can arrange for a future doctor’s appointment, all at their patient’s location.
This administration of out-of-hospital care has a controversial side, however. Michigan community paramedics have been authorized to administer certain antibiotics for this program, and some critics argue that this goes too far outside the parameters of paramedicine’s role in patient treatment. Michigan has certainly not handed the community paramedics prescription pads; they are authorized to give the first dose of one of seven commonly-needed antibiotics in order to start infection treatment immediately. They then set up a meeting with a healthcare provider, requiring the patient to see a physician to receive the full prescription and any other necessary care.
The role of paramedics in this program may be non-traditional, but there is little controversy about the savings that it has already provided for the Michigan hospital systems. Training the staff of 21 community paramedics cost $500,000, but their work saved $107,ooo in ER and ambulance costs in the first two months of the program. It continues to be cost-effective; thus far, costs for the community paramedicine unit have averaged out to $1,500 per day, almost 50% less than estimated $2,500 cost of bringing that patient to the ER. If that patient would have been readmitted but met with the community paramedic instead, savings could be greater than $10,000 per patient, because the hospital system would avoid the 30-day patient readmission fines enacted under the Affordable Care Act (over $25 million in Michigan last year).
Community paramedicine also saves time and trouble; when ambulance crews are freed up by community paramedics, response time to other urgent calls improves. The program also emphasizes continuity of care; community paramedics can answer questions about patients’ medications and connect them with other healthcare professionals and services, so that they are not left without guidance in the often complicated and bureaucratic healthcare system. Hopefully, this type of care will translate to better community wellness in the longterm.