Maryland County Launches MIH Program

Frederick News-Post, Md.

Feb. 23--In 2017, 105 high-volume 911 callers visited the Frederick Memorial Hospital emergency room 1,500 times and collectively amassed around $4.5 million in hospital bills.

Those same 105 residents resulted in more than 1,200 calls for service and 1,600 dispatches by emergency responders, which cost the county nearly $800,000, according to Frederick County Executive Jan Gardner.

The majority of those calls, though, weren't for medical crises or life-threatening injuries. Instead, a large number came from residents who needed help with chronic or recurrent health problems but had nowhere else to turn.

"For example, we had a gentleman who lived in a second-floor apartment in a building that did not have an elevator. ... A few years ago, health issues prevented the man from using the stairs. Anytime he had a doctor's appointment, he needed assistance getting down the steps. So, this man called an ambulance 28 times in one year -- about every other week," Gardner said.

In response to those growing numbers of non-emergency medical calls, the county announced the launch of a new community health care program at an informational briefing on Thursday.

The program -- coined Mobile Community Healthcare -- will identify frequent 911 callers through data from the Frederick County Division of Fire and Rescue Services, said Fire Chief Tom Owens. County paramedics will then team with at least one provider from Frederick Memorial Hospital to visit those callers' homes and try to resolve their medical issues in a more appropriate setting.

"That can include checking vital signs, checking home safety, reviewing medications with them and performing physical or mental health assessments, if needed," Gardner said.

The mobile team will also have access to resources from the Frederick County Health Department, including peer recovery and behavioral health specialists. Providers can refer at-risk patients to other county resources, such as Meals on Wheels or the Health Department's Adult Evaluation and Review Services (AERS).

The latter program is especially important given the growing number of aging adults in Frederick County, Gardner said. Staff members can evaluate the homes of senior or disabled residents and identify resources that would allow those people to remain in place, rather than be transferred to an assisted living center.

"Part of this program will be assessing other needs, like cleanliness or food availability," she said. "AERS once found someone who was living in a home without a functioning refrigerator. And obviously, that's something that would have a big impact on their health."

The program was launched after about a year and a half of data-gathering and inter-agency planning, Owens said. Most of the data analysis was done by Lisa Lessin, the community services coordinator for Frederick County Fire and Rescue and director of the new program.

Lessin was also responsible for one of the first successes of the fledgling program, Owens said. She was able to identify and reach out to the man who was having difficulty leaving his second-floor apartment, and asked if he would be willing to accept help from the county.

He and his wife said yes, according to Owens, and told Lessin that the stairs were to blame for their periodic 911 calls. She, in turn, contacted the manager of their apartment complex and had them transferred to a ground-floor apartment.

"That's an example of a very successful outcome with direct intervention that happened very recently," Owens said. "Inappropriate 911 calls have been a well-known, ongoing problem in many parts of the country. But where we've struggled, until now, is figuring out what we can do about it."

The mobile health team will start with about 20 of the most frequent callers and, hopefully, expand from there, Gardner said. The county is not currently allocating additional funding for the creation or implementation of the program.

An overarching goal is to save money for the county and for high-volume callers, according to Heather Kirby, the vice president of integrated care delivery for Frederick Memorial Hospital. Both Frederick County and Frederick Memorial Hospital spend significant funds on transporting and treating patients for medical problems that are not life-threatening.

Depending on emergency responders is also harmful for patients, who end up receiving care at one of the highest-cost settings in the medical field.

"Part of our interest in this is making sure they're getting the help they need in the right place," Kirby said. "Which is not usually a high-cost hospital setting, where they're often faced with very significant medical bills."