Who You Callin’ Community Paramedics?

Maine has its share of rural, and plenty of communities where what you call community paramedics might be of value. But what exactly are you calling community paramedics?

The term has come to be employed in a few different ways across North America. It could mean medics working in clinics or hospitals alongside or in the absence of higher-level providers. It could mean them making housecalls in underserved areas for things like simple checks and follow-ups. It could mean other expanded and nontraditional services for special populations. It’s meant all those things in various places, and could mean them all and more in Maine, where a dozen communities will participate in forthcoming community paramedicine pilot projects being organized by the state.

In fact, Maine is now the first state with a state-level community paramedicine coordinator to oversee such efforts: Kevin Ginnis, chief of Scarborough-based North East Mobile Health Services, the state’s EMS chief from 1986–96, author of the 2004 Rural and Frontier Emergency Medical Services Agenda for the Future and, by the way, the guy who coined the term community paramedicine.

The office marks another step forward for the concept, which, in this era of doing more with less, now seems to have arrived in the U.S. in a big way.

“Ten years ago the idea didn’t even have a name. Now it’s being cited in grant guidance by the Center for Medicare & Medicaid Innovation,” says McGinnis, who was among those who spoke about the concept at the NAEMSP show in January. “It’s definitely gained momentum. But the fact is, people have been doing this type of practice—mixing primary care and EMS response—for many years. Once it had a name and people could talk about it as a concept, we started to discover where it was being practiced and look at those practices, and the people doing them started to improve upon them based on the attention.”

Others are now increasingly keen to borrow their ideas, as their own communities’ needs and circumstances dictate. There’s not a single template. The general idea is to leverage EMS resources, including its mobility and 24/7 availability, to address healthcare and public health needs not being met. The where and how (housecalls, clinics, etc.) can vary. It requires linkages to other healthcare and social services for coordination of care, and is traditionally associated with rural and frontier areas, although its principles have also been employed in big cities.

Such programs can reduce strain on healthcare systems by preventing unnecessary transports and ED visits, bringing appropriate care to those who otherwise might not get it, and keeping providers’ skills tuned. They don’t generally require expansion of the paramedic scope of practice, although they should come with special education (see www.communityparamedic.org/Colleges.aspx).

What they do require are 1) a legal basis and 2) a way to pay for them.

“Our biggest obstacle has been a matter of interpreting the state’s enabling legislation for EMS, and whether it actually enables the practice of community paramedicine,” says McGinnis. “Many of us felt the ambulance legislation was sufficient. Others disagreed, so we’re taking the conservative approach and making sure we have our legislative ducks in a row. The governor’s office has sponsored a bill to assure us of that going forward.” Governor Paul LePage signed that bill into law March 29.

EMS services in Maine can also get compensated by Medicaid (known in Maine as MaineCare) for treating and releasing patients. That’s rare, but it’s helpful to advancing community paramedicine projects (Minnesota’s also achieved it). It’s not, however, the only way to get started; in Colorado’s Eagle County they used public health funds; in Pittsburgh, a major health insurer is involved. At the federal level, money’s even available through the aforementioned CMMI grants.

To sustain and grow such resources, however, there’s going to have to be some evidence of value. To that end, Maine’s projects will be required to build in research components to gauge their efficacy.

“Whether we move forward in EMS in a pay-per-call fashion or become folded into an ACO or medical home approach to paying for care,” says McGinnis, “the first thing we have to do is prove our worth. So as we establish our programs, they’re going to have to demonstrate a prospective research component, and benchmarks that will show things like the impact on hospitalizations and readmissions and ED use and ambulance service use.”

Sans complications, the Maine projects should be running by the end of the year. If, as proponents suspect, community paramedic programs will better serve health and resources, we’ll soon have evidence to show it.

Community Paramedic Resources

• CP Handbook: The Community Paramedic website offers a Community Paramedic Program Handbook produced by the Western Eagle County (CO) Health Services District and the North Central EMS Institute. The handbook is designed to be used by paramedic services or a community as a planning guide to develop a community paramedic program. It includes information on assessing program feasibility; considering state regulations; making the internal commitment; securing key partner commitment; determining how to provide medical direction; assessing community needs; determining program scope; developing policies and procedures; and evaluating the pilot phase. To request a copy and access additional resources, visit https://communityparamedic.org/.

• International Roundtable on Community Paramedicine, www.ircp.info/
• Community Paramedic Insights Forum, https://cpif.communityparamedic.org/
• Western Eagle County (CO) Ambulance District program, https://wecadems.com/cp.html
• Minnesota program, EMS World article
• Community paramedicine, EMS World article