Taking the pulse on community paramedicine in Pa.

Thanks to drastic changes in health care in recent years, many of us have at least heard of the term “super user.” A super user is someone who repeatedly visits the hospital, many times for help managing a chronic illness or follow-up medical care.

Unfortunately, as a result, the trend has added to higher health care costs and over extension of the emergency services system. Many of our hospital emergency rooms are now overcrowded, which greatly extends the wait time to see a physician and be treated.

The federal Centers for Disease Control and Prevention reports that the number of emergency department visits rose 44 percent from 1991 through 2010, while the number of hospital emergency departments decreased by 10 percent in the same time period. In addition, the average wait time to see a physician in an emergency department jumped from 45 minutes from 1998 to 2000, to 55 minutes from 2008 to 2010.

So, how do we ensure that emergency departments are reserved for the most severe medical cases, while also providing efficient, cost-effective, quality care to the super users and other less critically ill patients?

Many communities, including my home of Erie, have found success in establishing community paramedicine programs, which allow emergency medical services providers to deliver care to certain patients. Community paramedicine provides an effective alternative for those patients who need medical care, but do not necessarily need to visit the emergency room. Besides greatly expanding access to health care to various communities, community paramedicine promotes education and connects consumers with local resources to assist them in managing their conditions and keep them out of the hospital. As a result, the less expensive community paramedicine system helps to relieve programs like Medicare and Medicaid from the costly reimbursements accompanying visits to emergency rooms.

To help expand community paramedicine statewide and better control medical costs, I have introduced H.B. 1113, which would create the Community Paramedicine Services Act.

My legislation would direct the state Health Department to establish regulations to certify community paramedicine providers, allowing them to more widely treat patients in the commonwealth. It would also require insurance coverage and medical reimbursement for these services. Under the bill, EMS providers would be able to deliver care to patients in their own homes or in other appropriate settings, administering services such as health assessments, disease monitoring and hospital follow-up care in consultation with patients’ health care practitioners or an EMS agency director. By expanding community paramedicine, we can ensure cost savings to our current health care system while also increasing access to health care for underserved populations.

In crafting this legislation, my colleagues and I looked to other states that have instituted similar programs. Minnesota is the national leader in establishing a successful, statewide community paramedicine program, having passed legislation to do so in 2011. The state has effectively helped to keep elderly patients, people with mental health issues, and chronically ill patients from heading to the emergency room when it was not required, while also keeping associated costs contained. I hope Pennsylvania can soon follow in Minnesota’s footsteps.

In addition, to raise awareness and learn more about this issue, I recently held a public hearing on my legislation at the state Capitol in Harrisburg. Testifiers included representatives from the following organizations: Center for Emergency Medicine of Western Pennsylvania Inc.; Geisinger Health System; Highmark Inc.; EmergyCare; Pennsylvania Emergency Health Services Council Community Paramedicine Task Force; Ambulance Association of Pennsylvania; and Insurance Federation of Pennsylvania.

Overall, the feedback provided by these experts was positive. My colleagues, the hearing attendees and I heard from testifiers about how community paramedicine programs are currently operating, and how the state must take action to ensure patient safety and further examine reimbursement issues as the bill moves its way through the legislature.

But I believe Dr. Dan Swayze, a national expert on the subject of community paramedicine, most eloquently summarized our mission at the public hearing. The vice president and chief operating officer at the Center for Emergency Medicine of Western Pennsylvania Inc. said, “We are for the first time considering legislation that would help emergency medical services play a new role in our health care and in our communities. The bill would provide the funding necessary to help ensure our public safety net exists for those having medical emergencies, but would no longer wait until the patient calls 911 to help our most vulnerable residents.”

Health care is not a luxury; it’s a right. By expanding community paramedicine throughout Pennsylvania, we can ensure we provide efficient, cost-effective health care to those no matter where they live, while leaving our emergency rooms to those who need them most.