More than 75 million people live in rural (or partially rural) parts of the country that the federal government has designated as healthcare shortage areas, according to the most recent data from HHS. This means individuals in these areas may not have access to valuable healthcare services when and where they need those services the most. In addition, many emergency medical services (EMS) providers often respond to non-emergent situations. As a result, some states have begun to consider alternative solutions to bridge the care gap and reconsider the role of the EMS provider. Community paramedicine—a model of care that expands the role of EMS providers to meet healthcare demands—is one example.
What exactly is community paramedicine?
According to the Joint Committee on Rural Emergency Care (JCREC), community paramedicine “increases patient access to primary and preventive care, provides wellness interventions within the medical home model, decreases emergency department utilization, saves healthcare dollars, and improves patient outcomes.” It essentially allows paramedics to apply their training and skills beyond the traditional emergency response and transport model to expand the reach of primary care and public health services.
Various community paramedicine pilot programs have emerged nationwide as a way to address the Institute for Healthcare Improvement’s triple aim—that is, to decrease healthcare costs, improve health outcomes, and improve the patient experience. The industry may continue to see an increased focus on community paramedicine commensurate with the shift toward Accountable Care Organizations, value-based purchasing, and bundled payment models. That’s because in a community paramedicine model, EMS personnel work as part of the overall care team to deliver low-cost, high-quality, coordinated care.
For example, in 2012, Maine lawmakers removed regulatory barriers by authorizing up to 12 community paramedicine pilot programs throughout the state. Other similar programs have been initiated in Minnesota, Colorado, and Texas.
In Massachusetts, the Commonwealth Care Alliance (CCA)—a non-profit, pre-paid care delivery system for low-income and elderly or disabled beneficiaries—partnered with EasCare Ambulance, LLC to develop an Acute Community Care (ACC) model that relies heavily on community paramedicine. During the first 18 months of the ACC program, paramedics responded to almost 600 dispatches for the urgent care needs of more than 200 unique members. This model has been particularly helpful with these distinct clinical needs: members with urinary tract infections (UTIs), altered mental status/behavioral health conditions, respiratory distress, complex physical disability, and members nearing the end of their lives and engaged in CCA’s palliative care program.
However, to be successful, community paramedicine programs must foster collaboration among local stakeholders, including residents, elected officials, clinic and hospital administrators, and colleges/universities. This collaboration includes identifying best practices for funding community paramedicine programs. To date, many of these programs are supported through public and private grants. In addition, several CMS Healthcare Innovation Grant awardees receive Medicare fee-for-service for community paramedic services.
In Maine, municipal-based EMS agencies received funding for community paramedicine pilot programs as part of their regular EMS budget from the towns in which they were located. One private, nonprofit EMS provider requested a subsidy from its town. Ambulance services that were hospital-owned relied on the hospitals to absorb some or most of the cost of providing the community paramedic service.
Billing for community paramedic services also poses a challenge, as these programs must define a structure that works well for their individual needs. For example, the Minnesota Community Paramedics program sets forth various billing and documentation guidelines with the goal of tying services provided by a community paramedic directly to a physician. South Carolina follows a similar billing protocol.
Interested in learning more about community paramedicine? Consider these tips:
- Read up on resources. In 2012, the Office of Rural Health Policy published the Community Paramedicine Evaluation Tool to help communities establish a common framework for measuring outcomes and capturing data, both of which are a necessary part of competing for federal and state grants. The tool also helps communities assess needs and build partnerships to support a community paramedic program.
- Partner with the right billing vendor. Look for a vendor with a diverse background in billing for EMS, urgent care, and home care.
- Contact other community paramedicine programs. Inquire about the structure of the programs and how they overcame challenges along the way.
To learn more about our billing programs, contact Nancy Dolgin at NEMB at 508-297-2068 x232.
NEMB understands the importance of building meaningful relationships with entities and individuals within each municipality so we can ensure timely and compliant billing. Not only do we communicate regularly with fire and police departments, but we also take the time to get to know and network directly with town accountants, town managers, mayors, and others. We identify the key individuals within each municipality who can provide the critical information we need to bill ambulance services appropriately and as quickly as possible.
With nearly 10 years of experience in municipal ambulance billing, our credentialed staff members are trained in every aspect of effective municipal service billing. We specialize in auto accident claims that continue to challenge municipalities and result in significant revenue lost. We pursue auto accident claims as quickly as possible so our clients can take advantage of personal injury protection benefits before those benefits are depleted. Our expertise and focus on communication and relationship building help to maximize cash flow and ensure the fastest possible return on investment for the services provided. NEMB’s ambulance billing record has consistently yielded over a 90% collection rate.