Fla. County`s MIH-CP Program Already Saving Money

Jan. 11--Physician house calls may seem like an antiquated practice rarely performed anymore. But comprehensive medical care delivered in the home is experiencing a revival across the country. Health care costs are lower compared with the steep expenses at hospitals, clinics and offices, and patients enjoy better outcomes, research shows.

In its years-long struggle to find ways to contain the county's high costs for the health care crisis of the working poor and medically needy, Manatee County government launched an emerging health care alternative called community paramedicine in August. Also known as mobile integrated healthcare, the program diverts patients away from ambulances and expensive emergency room care and into other, cheaper parts of the county's health care system. House calls are another vehicle.

The county's program is proving its worth after only 90 days, diverting an estimated $45,274.20 in health care costs. Those savings come from eliminating some ambulance rides, which cost an average of $969. That expense is classified as diverted when the patient decides to skip an ambulance ride to the hospital and accepts care at an urgent care center or doctor's office. That amount only involves EMS transfer and would be far greater adding hospital expenses ER doctor's fees.

Community paramedics operate well beyond their traditional emergency role by providing some primary care, including teaching patients about their medications, preventive medicine and other health care issues. Mental health and substance abuse issues are also addressed.

The national home-based health care resurgence is partially being driven by high-tech, portable medical equipment. Thanks to grant money, Manatee County purchased and outfitted two new vehicles with all the equipment found in ambulances except the gurney and added extras, too.

The companionship and compassion -- and even supply food on occasion -- are perhaps just as significant to patients, comfortable in their own residences, who get visited by the same paramedic. Cost cannot be attached to kindness.

The county currently employs only two community paramedics along with a supervisor, all part of the county's Public Safety Department. Such a small staff is having a big impact. The program regularly sees 26 patients, but by mid-December the overall patient load reached 358. Most of those interactions involve patients who access two of the most expensive components of the health care system frequently -- via emergency room visits and 911 calls. They are known as "high system utilizers." Reducing ER visits is also critical to containing the county's cost for indigent care.

This is one of the major challenges in getting a grip on costs, especially for Manatee Memorial Hospital. As the county's safety-net hospital, MMH treats the vast majority of poverty-stricken, medically needy patients.

For several years now, millions in taxpayer dollars have been reimbursing -- only partially, not in totality -- private hospitals and physicians for the free health care given to the working poor -- not the homeless and jobless who qualify for Medicaid, but job-holders earning paltry wages who do not qualify for any federal or state government health care assistance.

The first phase of a Medicare home care project determined medical costs savings stretching from $1,000 to $3,000 per patient. Another independent study, this one conducted by the Department of Veterans Affairs, found home-based care for veterans reduced hospital stays by 62 percent, cut total costs by 24 percent and saved on average around $9,000 per patient. Home health care is a proven winner.

"A lot of things can be prevented and people can be educated to more appropriate resources," Chief of Community Paramedicine James Crutchfield told Herald reporter Sara Nealeigh.

The community paramedicine program certainly helps prevent unnecessary hospitalizations and lowers hospital re-admissions of chronically ill patients (which can incur costly penalties from the federal government should high-risk patents return within 30 days). Because there is limited primary care access across the country, these paramedics are doubly valuable.

Cost savings aside, the value of this innovative program can also be demonstrated by better educated patients, improved medical outcomes, and a healthier community. Kudos to Manatee County.

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