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Check Your Bus Ticket First

If you’re like me, it’s hard to determine what the real facts are about implementing mobile integrated healthcare (MIH) or community paramedic (CP) programs in your community. Does the thought of adding these services to your fire service agency give you a headache or upset stomach?

Before you jump on the first bus driving these programs, there are a couple of things to consider. Allow me to play devil’s advocate and speak to the other side of the arguments being given to implement MIH-CP. I want to convince you these programs are not going to be mandatory for your fire department to be in the mainstream of EMS.

These program aren’t for everyone.

In recent statistics, it’s estimated there are 29,800 fire agencies in the United States. Another statistic, from NASEMSO in 2011, reports there are 19, 437 EMS agencies. Clearly there’s some cross-over between these two numbers.

If 500 fire departments engaged in this adventure, it would be less than two percent of fire departments. Not only is this not for everyone, the majority will not be engaged in either of these programs.

There is no national model for either of these programs.

Unlike EMS, neither of these programs is based on the scope of practice, core competencies or education standards. A community paramedic or MIH worker is likely to be different in each state. You can’t just take information from a program in another state, plug it into your department and expect it to work.

Despite the hype, it’s rare for an agency to generate revenue.

Even if revenue is generated, the question is whether there’s significant revenue to pay for the program now and in the future. Is your budget so solid that you can add a significant expense without the need for a revenue stream to cover those expenses?

There’s no evidence (yet) to show these programs make a long-term difference.

I understand the concept of reducing costs for hospitals by preventing readmissions, but does that equate to better patient care? I’m not saying it can’t make a difference. My question is, can we predict that agencies that get into this will be around in five years with significant results?

Before I get hate mail from programs that are helping patients, let me say I’m sure there are many cases where you’re helping patients. I just don’t see the majority of fire departments engaged in this practice and generating revenue to cover all expenses.

Reimbursement, if received, is voluntary—not mandatory.

Will that change at some point? Many people predict sweeping changes will impact EMS just like it has started to affect hospitals and physicians. The change in reimbursement for EMS hasn’t started yet, despite claims it will soon require significant conversions to a new model. But what will that model look like and what will fire departments need to receive reimbursement?

There’s no single, clear answer. How hard will it be to receive funding for MIH or CP if you’ve been providing the services for free?

Is it true that community paramedicine reduces the volume of unnecessary EMS calls?

Unless you work in an urban fire department with a high call volume, I doubt you’re wearing out the tires on your ambulances or first response vehicles going to needless calls. Does anyone have a credible statistic that demonstrates what number, or percentage, of calls can be decreased to 911 via one of these programs? At this point in time, fewer transports equal less revenue.

What will be the effect on your workforce?

The majority of EMS personnel weren’t educated or trained to the necessary level, which is somewhat different from EMT or paramedic. Are they ready to have a different perspective toward patient care? Will these new job duties give your workers satisfaction in caring for their patients? Will changing the work dynamic impact the longevity of EMS workers?

What should you do first?

The first critical step to take before even considering an MIH-CP program is to conduct a needs assessment of your community; determine if your community needs your fire department to engage in these non-traditional services. Is there a critical need for fire service personnel to expand their role of emergency providers to a non-emergency service?

Another step will be to create a budget and determine what the expected expenses and revenue potential, if any, will be.

Many people have heard me use the analogy of the fire service not just being on the EMS bus, but driving the bus. In the case of MIH-CP, I believe that waiting at the bus station to find the right bus going to the right destination makes better sense than jumping on the first bus that comes along.

The EMS Section is working to help get you the answers you need to better determine the future of your EMS operations. Stay tuned for more information.

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