Community Paramedics treating a patient. Photo by leaf

How will changes in the Affordable Care Act affect Paramedicine? – The house call Paramedic #ACA

The Affordable Care Act and ever increasing insurance costs/premiums as well as the advancement of Emergency Medical Services ran through ambulances and fire departments in communities throughout the U.S. has created a movement for Paramedicine. That is — the call to have more and more paramedics act as a conduit between the sick patient and their doctor, with transportation as the very last option.

Many counties across the country are either in test phase or in full blown use of these programs where Paramedics are going out on the house call, no lights or sirens, to access the patient, make sure they are taking their medications, that the house is safe and clean and then to provide their doctor with feedback, while taking care to avoid un-necessary trips to the ER.

In practice, this is crucial to avoid un-necessary ER trips, frees up the ER for actual emergencies and provides the patient with a level of home care that they might not get unless they were at the hospital or their doctors office.

These programs provide needed follow-up for ongoing potential critical and life threatening conditions while at the same time limit the amount of transport and hospital time that might otherwise not be crucial at that stage.

By serving as the in-field eyes and ears of the patients primary physician, the patient gains a level of comfort and care that is vital to their on going treatments and allows the paramedic to develop a relationship as well with the patients.

Aside from all these wonderful and exciting things, there are some issues that have come up as a result of the programs implementations. Mostly, they are positive, with many patients and Physicians feedback leaning towards the continuation of the practice.

In other instances, many nurses and their associations see this practice as a threat to their expanding careers as well as a potential reduction in ER patients, which in itself would have the effect of reducing the need for more trained ER nurses and staff.

The claim is that the Paramedics lack the required training to properly access and care for the patients as well as their inability to properly understand the primary practice and hospital relationships.

While there is not conclusive evidence that the program, when implemented with knowledgeable and caring Medics, is a failure, it is also too soon to tell if this is the way of the future for our teams in the field

Costs associated with this usually must be absorbed by someone and at this stage that critical line of revenue for the Ambulance companies is not fully monetized.

For your traditional Ambulance event, where there is a transport involved, that care is easily monetized through an Insurance carrier or the Government. With this type of care, where there is no transport, the costs must be absorbed either by the Ambulance Company, the County, city or State. Not knowing or having this clarity before and during implementation can be catastrophic for the providers.

 Then there is the big what-if when it comes to resources available to manage this type of care while at the same time, having those same resources available for Emergency events that occur with regularity in the field.

So far, there are too many what-if’s with this program. While those of us who understand the rationale for it are always in favor of expanding our career potentials and abilities, our employers who cut our paychecks, need a clearer and more readily accessible way to be reimbursed for the services.

Also it is important to note that this practice, while adhering to and attempting to meet the Criteria that is mentioned in the Affordable Care Act, not knowing where the act is going in the next few years under the new administration in Washington, leaves a big huge question mark on the programs on-going viability. Despite challenges in some areas, the fact is that Community Paramedicine has demonstrated a true improvement in overall patient care. There is substantial evidence that the program helps to cut down on Emergency Department readmissions.

We will be exploring this subject in greater detail as the week’s pass, with input from the field as well as our highly trained and informed readers, such as yourself, to help us get a clearer and more refined picture of the program.

So for now, the jury is still out.


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Jack Murphy
Jack Murphy is a licensed firefighter, EMT and EMS Instructor in Michigan and California, holds a JD in real estate law and BA in History as well as numerous industry related certifications. These days Jack teaches a Hybrid EMT program at a small College in the Los Angeles area.