psow 2016 - community paramedicine in wisconsin
TRANSCRIPT
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COMMUNITY PARAMEDICINE IN WISCONSINWHERE ARE WE AND WHERE ARE WE GOING?
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Community Paramedic: Accountable Care Partners
● Viable option for improving the experience of care, improving the health of populations and reducing per capita costs of health care
● Bridge existing health care gaps, avoid duplication
● Reduce the cost of overall health care expenditures
● Reduce stress on vulnerable patients and improve care coordination
● Reduce hospital readmissions and emergency department utilization and avoid penalties
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THE VALUE of CP in ACCOUNTABLE CARELinking Primary Care & EMS
Enabling Legislation,
Credentialing
Reimbursable CP Practitioner
Services Identified
Partnership Between
Hospital and EMS or FD
ED Utilization Complex Patients Without Services
Patient Primary Care Plan, PCP
Driven
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COMMUNITY PARAMEDIC WORKFLOW
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WHAT DOES SUCCESS LOOK LIKE?
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NEW HANOVER REGIONAL – NORTH CAROLINA
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ABBEYVILLE SOUTH CAROLINACOMMUNITY PARAMEDIC EVALUATION REPORT
NOVEMBER 2015ED UTILIZATIONCP PATIENTS – 58.7% DECREASE VS. CONTROL – 4%
INCREASEINPATIENT UTILIZATION
CP PATIENTS – 60% DECREASE VS. CONTROL – 500% INCREASEED CHARGES
CP PATIENTS – $879 DECREASE VS. CONTROL – $126 DECREASEINPATIENT CHARGES
CP PATIENTS – $1,249 DECREASE VS. CONTROL – $19,960 INCREASE
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LEGISLATION IN WISCONSINSTAKEHOLDERS
• PROFESSIONAL AMBULANCE ASSOCIATION OF WI - PAAW
• PROFESSIONAL FIRE FIGHTERS OF WISCONSIN – PFFW
• WISCONSIN EMS ASSOCIATION - WEMSA
• WISCONSIN STATE FIRE CHIEFS ASSOCIATION – WSFCA
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LEGISLATIVE PROCESS• Process started by PFFW and Rep. Katrina Shankland (D) Stevens
Point
• Bill drafted in late summer 2015
• Outreach to other medical groups:• WI Nurses Association• Medical Society of Wisconsin• Office of Rural Health• DHS
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LEGISLATIVE PROCESS
• Stakeholder phone conferences started by PAAW and archived at www.paaw.us
• List serv started by Rural Health and archived at www.paaw.us
• Stakeholder meeting in Stevens Point – summer 2015
• Support offered by Rep. Amy Loudenbeck (R) Clinton
• Legislation session ended with bill in draft form
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LEGISLATIVE PROCESS• All inclusive Stakeholder group reconvened May
2016
• New draft circulated July 2016
• General consensus across the board on issues
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HIGHLIGHTS OF BILL DRAFT• Expands definition of EMT to add CP function to current
definition
• Actions and training to be authorized by DHS
• Agreement with a hospital or physician
• CP endorsement by DHS
• CP must be part of ambulance provider or hospital
• No Medicaid reimbursement in the bill
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NEXT STEPS
• Introduce vetted bill when legislative session opens
• Build consensus across other disciplines
• Reach out to local legislators to garner support
• Establish discussions with local hospitals to forge partnerships for pilots and/or services
• Work to increase training opportunities for certification
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WISCONSIN PIONEERS• Green Bay Fire Department
• Greenfield Fire Department
• Madison Fire Department
• Milwaukee Fire Department
• Ryan Brothers Ambulance
• West Allis Fire Department
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MILWAUKEE FIRE DEPARTMENT COMMUNITY PARAMEDIC
PROGRAM
Captain Michael Wright NREMT-P CPMIH TEMS
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PILOT PROGRAM RESULTS OCTOBER
PATIENT 6 MTH PRE 6 MTH POST % CHANGEHours of engagement
DA 33.5 15 25 66.67RB 17 2 4 100CS 15.5 8 3 -62.5MK 15 1 1 0TB 15 3 0 -100BL 12.5 2 0 -100SR 38.5 10 1 -90CH 17 9 1 -88.89NS 17 4 2 -50TOTALS 181 54 37
1
-150
-100
-50
0
50
100
150
66.67100
-62.50
-100 -100 -90 -88.89
-50
October 2015 Pilot Data
DA RB CS MK TB BL SR CH NS
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PILOT PROGRAM RESULTS NOVEMBER
PATIENT 6 MTH PRE 6 MTH POST% CHANGEHours of engagement
RG 14 9 0 -100CS* 7.5 4 2 -50DP 27 29 51 75
TW* 16 12 1 -92JS 13 2 0 -100
GW 7.5 10 16 60JA 16.5 4 1 -75
MB* 5 3 3 0MM 13.5 14 9 -36
TOTALS 120 87 83
1
-150
-100
-50
0
50
100
-100
-50
75
-92 -100
60
-75
0 -36
November 2015 pilot data
RG CS DP TW JS GL JA MB MM
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PILOT PROGRAM RESULTS DECEMBER
PATIENT 6 MTH PRE 6 MTH POST % CHANGEHours of engagement
RL 21 38 14 -63.15JN 14.5 4 0 -100HH 16.5 1 1 0LL 22 14 0 -100
PG* 23 13 4 -69DM* 15.5 21 15 -28.57JJ* 4.5 21 7 -66.66GT* 4.5 5 3 -40MT* 4.5 6 0 -100DT 21 6 7 14.28
TOTALS 126 123 51*did not complete program
1
-120-100-80-60-40-20
02040
-63.15
-100
0
-100
-69
-28.57
-66.66
-40
-100
14.28
December Pilot data
Series1 Series2 Series3 Series4 Series5Series6 Series7 Series8 Series9 Series10