Ky. Hospitals Fund MIH-CP Program After Budget Cuts

Lexington Herald-Leader

Three Lexington hospitals have stepped up to fund a Lexington Fire Department program that has slashed ambulance runs and helped those who need medical care but not emergency services.

UK HealthCare, CHI Saint Joseph Health and Baptist Health Lexington have agreed to donate $200,000 to keep the community paramedicine program going. Due to budget constraints, the program was set to run out of funding in January.

“It is an outstanding program,” said Mayor Linda Gorton at a news conference Monday to announce the gift. “As a registered nurse, I understand how important it is. Community paramedicine is a win for everyone, especially citizens, whose quality of life is often improved.”

In 2017, the fire department started the community paramedicine program, which dispatches emergency medical technicians and paramedics but not ambulances to treat people who frequently call 911 but don’t necessarily need emergency medical care. A $252,201 federal grant, plus $25,221 in city money, was used to start the program.

The federal grant ran out last year. At the same time, the city of Lexington was clamping down on expenses as its revenue growth slowed. That meant the city only had enough money to keep the program going until January.

The $200,000 in funding should keep the program running for more than a year, city officials said Monday.

The program has helped the city cut its ambulance costs and free up ambulances for medical emergencies, said Lexington Fire Chief Kristin Chilton.

“We have already experienced a 6.5 percent decrease in EMS runs,” Chilton said. That 6.5 percent decrease is from 2017 to date.

“This number is significant all by itself, but it is especially impressive when you consider that our EMS numbers have historically increased by 8 to 9 percent each year,” Chilton said. “Prior to the start of this program we anticipated needing to add a new ambulance to our fleet every two years in order to keep pace with patient demand.”

In 2017, prior to full implementation of the program, the city spent nearly $500,000 to staff a 12th ambulance because of a steep increase in the number of people dialing 911. Calls increased by about 7.5 percent each year for the prior three years.

Abuse of ambulance services for non-emergencies has been a long-standing problem. In 2014, a Lexington Herald-Leader and WKYT investigation found in 2013, ambulance crews responded to 33,328 total calls, about 92 a day. Of that total, there were 11,829 unspecified “sick cases” and “injuries.” The fire department doesn’t track how many of those calls are non-emergencies, but fire officials estimated in 2014 about 10 percent to 20 percent of the 11,829 sick calls didn’t require emergency help.

Under the federal Affordable Care Act, hospitals can be penalized if patients are discharged from emergency rooms and then re-admitted. The paramedicine program helps hospitals keep emergency room re-admittance rates down. In addition, insurance companies sometimes don’t reimburse or fully reimburse hospitals for emergency room care if the patient’s medical condition is not an emergency.

Lexington Firefighter Capt. Seth Lockard has been part of the community paramedicine program since it started in 2017. Lockard said they recently had a patient who has previously called 911 more than 45 times in a year. After being connected to the community paramedicine program, that patient called 911 twice in the past nine months.

Another patient, who was homeless, would often call 911 and ask to be taken to the emergency room when it was cold. The woman couldn’t stay in a homeless shelter because she had a service dog that didn’t have all of its immunizations. The community paramedicine program found a veterinarian who was willing to give the dog its shots so the woman could stay in a shelter, Lockard said.

“Some of what we do is education,” Lockard said.

Some people don’t understand that an ambulance or 911 is not a primary care provider.

“We also have people who have a limited amount of minutes on their phones,” Lockard said. “They can’t call their doctor and be put on hold and then call their insurance provider and be put on hold again. That will eat up their minutes. Sometimes we just have to make phone calls for people to get them into a doctor.”

Lexington is not the only city that has turned to community paramedicine to cut costs and help connect patients to primary care and other community-based services.

Michael Poynter, executive director of the Kentucky Board of Emergency Medical Services, said there are eight pilot community paramedicine programs throughout the state. There are programs in Louisville, Oldham County, Paducah and Montgomery County.

“Lexington is raising the bar statewide and nationwide,” Poynter said.