NFPA Journal - January/February 2020 - 64

EMS
Revolution

THE

64 | NFPA JOURNAL * J A N U A R Y / F E B R U A R Y 2 0 2 0

THE NEW EMS A community paramedic from MedStar
assesses a patient at her home as part of the organization's
readmission prevention program. Inset, a MedStar 911 triage
nurse assists a low-acuity caller over the phone rather than
sending an ambulance for a minor ailment.

pay EMS providers to treat patients
using these less-costly alternatives.
In early 2019, the Centers for Medicare and Medicaid Services announced
a new five-year pilot program called
the ET3 model-short for emergency
triage, treat, and transport-where the
federal government will for the first
time pay participating EMS agencies
to bring patients to alternative destinations besides the ER, as well as to
treat patients at home, either in person
or over the phone. The program also
encourages local governments and
other entities that operate 911 dispatches to establish a separate medical
triage line for 911 calls from low-acuity
patients-that is, patients who require
less-intensive care for their ailments,
such as chronic, non-life-threatening

conditions. Several states have also
recently passed laws to allow EMS
more flexibility to be paid for treating
patients at home, and utilizing other
options outside of the ER.
According to EMS leaders and health
care officials I spoke with, the evidence
suggests that we could be on the brink
of a dramatic shift in how health care
is delivered in the United States. Many
think that MIH will soon be a ubiquitous part of the daily function of EMS
and fire-based EMS nationwide.
"Much like EMS was the future of the
fire service in 1997, mobile integrated
health care is the future of EMS in
2020," said Matt Zavadsky, president of
NAEMT and an executive at MedStar
Mobile Healthcare in Fort Worth, Texas.
"Cities have a standing army of health

PREVIOUS PAGE , DANIEL HERTZBERG; MEDSTAR MOBILE HEALTHCARE

This proactive approach to EMS is
one of numerous examples of mobile
integrated health care programs (also
known as community paramedicine)
that have taken root across the United
States in recent years. A 2018 survey
conducted by the National Association
of EMTs (NAEMT) found that more
than 200 EMS systems across the
country are now doing some form of
MIH; a decade ago, there were only
four. The growth is only expected to
continue.
Last summer, NFPA published a new
document to help facilitate that expansion. NFPA 451, Guide for Community
Health Care Programs, lays out the
considerations for EMS agencies that
want to build an MIH or community
paramedicine program from scratch.
The guide was developed by technical
expert volunteers, many of whom have
already built successful programs,
made mistakes, and gained key insights
along the way (see
"Lessons Learned"
on page 66).
While the details
of specific MIH
programs can
differ widely from
system to system,
the overall concept is usually the
same: instead of
reflexively taking
every patient who
calls 911 to the emergency room-as
EMS has done almost exclusively for
decades-agencies are now exploring a
range of other options. These include
treating patients at home, transporting
them to alternate destinations like a
doctor's office or urgent care, or even,
as with SAFD, forming relationships
with certain high utilizers to understand the underlying causes of their
chronic medical issues and to try to fix,
or at least manage, those causes.
EMS agencies that have rolled out
MIH programs have seen dramatic
results, including a drop in 911 calls,
increased revenues, happier patients,
and reduced overall health care spending. As a result, hospitals, private
insurers, and even the federal government have begun, for the first time, to
NFPA Journal - January/February 2020

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