East Baton Rouge Parish and local hospitals are working out the details of a new program designed to help patients with chronic illnesses avoid unnecessary and expensive visits to emergency rooms.
The Metro Council is set to discuss the Emergency Medical Services Department’s Community Integrated Health Program at Wednesday’s meeting. Under part of the program, hospitals would pay EMS to coach patients and their families on how to better manage health conditions, such as congestive heart failure, by taking medication as directed and through regularly scheduled doctor’s visits. The fees hospitals pay for that service are still being negotiated.
“The reason why we’re doing it here is there’s an extreme overload of the 911 system and also the (hospital) emergency departments as a whole,” said Bryant Hernandez, who coordinates the program for EMS. “We have a lot of people that use the system over and over and over again because they don’t have the resources to take care of themselves properly outside of the emergency departments.”
EMS found that during a six-month period, more than 7,100 calls were made to 911 but involved just 2,000 patients. Ambulances made about 5,400 trips to hospital emergency rooms.
By having EMS paramedics make regular calls and/or visits to repeat patients, a lot of trips to the hospital could be eliminated, Hernandez said.
Interim EMS Administrator Chad Guillot said the city-parish’s Community Integrated Health Program is part of a growing national trend.
The programs help cut costs for patients, hospitals and emergency services departments, as well as reducing the load on the 911 system, Guillot said. Lowering the number of unnecessary ER visits and preventing avoidable hospital admissions frees up the hospitals’ resources for emergencies and shortens the time people spend in emergency rooms or waiting for a response to a 911 call.
EMS launched a pilot version of the program at the end of September.
The department targeted “higher utilization” patients, those among the 2,000 that made repeated emergency calls and ER visits, Hernandez said. The pilot program now helps 18 patients, Hernandez said. Before enrolling, those patients combined for an average of more than 35 calls to 911 a month, and roughly half the time, the patients ended up in an ER.
In the month after enrolling, the patients made 10 calls to 911 and eight ER visits, Hernanadez said. However, those eight ER trips took place after normal business hours, when the paramedics in the program weren’t around to talk to the patients.
Guillot said EMS hopes to expand the program so paramedics can advise patients 24/7.
As the program builds, EMS hopes to reduce the burden on the 911 system and both emergency rooms and hospital budgets, Guillot said.
Hospitals are under increasing pressure to prevent avoidable readmissions. Last year, Medicare, the federal health program for seniors, cut payments as much as 3 percent at hospitals where patients were readmitted within 30 days of being discharged.
The EMS program includes a readmission avoidance component, Guillot said. For hospitals, having paramedics make home visits or calls is a much cheaper alternative than the Medicare penalties.
EMS has discussed the program with all of the Baton Rouge-area hospitals and eventually hopes to work with all of the facilities in the region, Guillot said. For now, EMS can provide the service without adding additional workers or equipment. As the program grows, those issues will have to be addressed.
“It’s another level of care, and it’s the direction the EMS industry is going,” Guillot said.
The approach has provided encouraging early returns in other cities.
Golder Ranch Fire District in Tucson is one of a number of Arizona fire departments that have launched these sorts of programs. On June 30, Golder Ranch began targeting patients who had just left the hospital after being treated for a heart attack, congestive heart failure, pneumonia, diabetes or chronic obstructive pulmonary disease. Paramedics made regular, in-home visits to the 12 patients who enrolled in the program.
“What I can tell you is that it’s absolutely achieving the goals we were looking at,” Battalion Chief Josh Hurguy said Friday.
A year earlier, each of those patients averaged two trips to hospital ERs, Hurguy said. During the first three months of the program, none of the patients called 911 or went to an ER. None were readmitted to a hospital within 30 days of being discharged. Instead, patients made more visits to their primary care physicians, seeking care through a more appropriate route.
It costs the Fire District $84.58 for each 90-minute visit. Paramedics made at least six visits per patient during the 30 days after the patients were discharged from the hospital. On average, paramedics made 6.5 visits per patient, for an average cost of $549.77.
Meanwhile, the average cost to take a patient to the hospital by ambulance is about $1,300, Hurguy said. That works out to about $750 in health care savings, plus whatever out-of-pocket costs a patient might have incurred.
“For us and our resident population, it’s a slam dunk. The folks in it love it,” Hurguy said. “They love the guys coming into their house. They love the extra attention, the time that they spend with them going over their discharge instructions.”