A law passed with little fanfare could end up making a big difference to people who need routine medical care, especially those in rural areas. It could also save money.
A bill, introduced by Gov. Paul LePage and sponsored by Rep. Mike Willette, R-Presque Isle, calls for the creation of up to 12 pilot projects that would allow paramedics to provide medical treatment to patients in their homes.
For example, a patient with a chronic lung or breathing disorder who needs regular medication and breathing treatments would be referred to the program by a doctor or health care organization.
The paramedic would go to the patient’s home to check vital signs and make sure she is taking her medications and following through on other treatment. This would be done during down time between emergency calls.
Such care will lessen the chances of the individuals in the program needing to access the emergency room or be hospitalized once again. This is better for patients and could save money because hospital care is much more expensive.
It is important that review of the pilot projects include a close look at costs. Using paramedics during down time in their shifts is likely to save money. Paying paramedics to do the work of certified nurse assistants won’t.
Northern Maine Community College in Presque Isle has already begun a training program for community paramedicine.
Similar pilot projects are already under way in several states. In Fort Worth, Texas, Dr. Jeffrey Beeson, past president of the American College of Emergency Physicians, told the Associated Press that allowing paramedics to visit patients can reduce the number of ambulance calls. He said local paramedics who normally would have spent downtime waiting for such calls have used that time to visit more than 200 patients over the past two years.
Dr. Michael Wilcox, of New Prague, Minn., runs a similar program that has treated more than 400 patients since 2008. He said paramedics there have been doing the work for free but that he hopes the federal government will pick up the tab — if the program proves it can save money.
Colorado approved a five-year pilot program to determine how much money the state and federal government might save in Medicare and Medicaid spending in Eagle County, which has a population of about 52,000, many of them in rural areas.
Tracy Hofeditz, a board member of the Colorado Academy of Family Physicians, said more than 600,000 people who are uninsured in Colorado could benefit from such a program without sacrificing the effectiveness of emergency responders.
This program can be a real help, especially to the state’s rural areas. Periodic reviews will help ensure it lives up to its promises.
Although the idea has merit, such a program would require each case to be individually evaluated to determine if the needs of the patient can be addressed by a paramedic within the scope of their practice. This is important, from both an ethical and legal perspective, to protect the patient, the paramedic and the provider from medical errors and litigation. Home health agencies are the usual choice for providing care and certainly could contract with advanced practice nurses or physician associates/assistants to extend their ability to care for home-bound patients. At the same time, this program does not address the ability of advance practice nurses (NP/FNP) or physician associates/assistants (PA’s) to also provide care with a higher level of training yet retaining cost containment. Perhaps each rural area, if going under county or hospital cachement regions, can be evaluated to make the best use of existing resources for extended physician providers, whether paramedics, NP/FNP’s or PA’s. Certainly the wealthiest nation in the world need not continue with third-world care in rural areas.
Perhaps you have not been keeping up to date on the recent developments of the state of healthcare in this state. Many under served and deserving people have lost their health benefits. Good luck finding top-tiered providers to go out and do house calls, those times have come and gone. Dr.’s in the 3rd world, however, do make housecalls. Ironic, isn’t it?
Where are they going to find Paramedics who, after a full day at work and a full volunteer shift taking emergency calls, are willing to visit patients?
Most rural ambulances are volunteer, or pay a pittance.
The towns they serve may help to defray the cost of training, by donating a few hundred dollars to be split among all the EMTs and Paramedics on the squad. The rest of the training costs come out of their own pockets. Training and keeping up with changes in policy at both federal and state level takes time and money. Will the law provide funds? The towns certainly can’t afford to pay them a living wage, and those same people who need medical care have lost their insurance and cannot afford to pay.
There’s already no time with their families due to the lack of qualified volunteers who can relieve them. Many volunteers are on call at all times when they aren’t working to make a living. This may work in a big city, but not in the majority of Maine, the rural areas where the people who need the help live.
I beleive that in most of the pilot areas nationwide, this program is seen as a way to reduce the number of patients going to the E.R.’s for things that can be done by “minimally trained” professionals. I say “minimally” as opposed to the ER staff of Dr’s and nurses, not minimally in the range of emergency care these fine people provide us.
Quite often the “care” could be done by a trained bystander or relative, but sadly there aren’t any around, so the patient has to call 911 and until now EMS basically had to take them to the hospital. The overuse of the ER’s is having a negative effect on our healthcare system, Quick Care Clinic and programs such as this provided needed relief to overtaxed hospital emergency departments.
Proactive community medicine is a necessary component of fixing our broken healthcare system. Of course it won’t be a real option in areas served by primarily volunteer services, but those areas tend to be more self-sufficient as opposed to the larger “urban” areas. Glad LeRage gets one right once in a awhile.