Texas EMS Department Reforms Operations With ACP Program

Washington County EMS (Texas) has ambitiously launched an Advanced Community Paramedicine Program in what department officials consider a reform of how their system operates.

“People keep talking about healthcare reform. We decided to just do it,” says Washington County EMS Director Kevin Deramus.

He’s a firm believer that adding ambulances as call volume increases is unsustainable, and that the key to managing costs is to manage call volume. Funding the new ACP program this year cost the department $220,000 less than adding another ambulance, he said, which they can now put off for several years.

Along with the savings expected from their ACP services, the program is projected to save up to $800,000 over three years.

The program is now underway following 18 months of preparation.

The idea is to use advanced level paramedics to fill identified gaps within the community to meet three goals:

1. Reduce the occurrence of medical crises for those with medical conditions known to benefit from close medical monitoring.
2. Ensure that an additional experienced paramedic is available on critical level calls by responding alongside paramedic ambulances.
3. Reduce usage of the 9-1-1 system by frequent callers.

“I think one of the things that sets our program apart from some may be the training program and the overall reform that the program is doing to ‘EMS’ as we know it here in Washington County,” Deramus says. “We truly are trying to change the mindset and cultivate a smarter, healthier and more efficient healthcare community.”

Building the Program

In July 2010 during an annual budget workshop the Department of EMS presented their new approach, and in January 2011 the department laid out its next five-year strategic plan, of which a large portion was to design a system that is fiscally sustainable for local taxpayers, and to revise the department to become even more efficient with limited resources.

Deramus credited the Eagle EMS system in Colorado for assisting them with lessons learned from their ACP program.

Washington County EMS did need to invest in the program, as expenses included creating their ACP training curriculum, which took about 6 months, and hiring three additional employees.

However, the state applied to the federal government for a "1115 waiver," Deramus said, for which the government approves innovative healthcare programs aimed at saving taxpayer money. Washington County EMS expects to receive revenue through this program beginning next month and then annually.

Training

The program used a curriculum developed with Blinn College in Brenham, TX. The course included 60 hours of internship training and 60 hours of simulation lab training. The 60-hour lab component was held at the Texas A&M Health Science Center simulation lab in College Station, Texas.

Deramus said the ACPs are also the most senior paramedics at the department, with the most experience and patient contact. They completed their training about four weeks ago and started seeing patients during home visits on Sept. 1.

Aside from the training, however, the agency believes that the key to success for the program will be years of community involvement and relationship building.

Reforms

The reforms at the department involve “turning downtime into resourceful time,” Deramus said.

“For us, it’s changing the way we operate,” he said.

The ACPs will aim to meet the three outlined objectives as well as engage in additional efforts aimed at community building and cost saving. These will include providing vaccinations for county employees, providing services at the county jail, assisting organizations with safety plans, public access defibrillation planning and CPR education.

“There are a lot of areas in the county where we believe we can make a difference,” Deramus says.

Home Visits

Currently, 22% of the annual call volume in Washington County is from about 300 patients “who call us a lot,” Dermus says. The department now identifies these patients and enters them on a registry for proactive care by the ACP program, “so we seek them out first,” Deramus says.

There are additional ways that patients can be entered on the registry:

• During a normal 9-1-1 response the primary attending paramedic can request an ACP visit;
• Recently discharged hospital patients with one of the department’s targeted health issues can be placed into the program for follow up visits from the ACP program;
• Any patient, family member or caregiver can suggest a patient for enrollment and all requests will be considered by the program manager.

The ACPs aim to educate these patients, assist them with local resources, and ensure they have a primary care physician and transportation. For appropriate patients, the ACP will determine the best alternative treatment location and arrange for the patient’s transportation and/or admission. Ambulance transport to the emergency room always remains an option

As an example of the effectiveness of home visits, Deramus shared the story of a patient he started seeing after he was transported 17 times at a total cost of at least $70,000. “Now he hasn’t been transported in 12 months. Do that times 300 patients—it saves an enormous amount of money.”

See more about Washington County's ACP project on their website.

Heather Caspi is an associate editor for EMS World.