Michigan mobile health initiative aims to cut hospital costs, readmissions

Community EMS, a Southfield, Mich., ambulance and consulting company, has begun pilot testing a mobile health initiative to use paramedics and telemedicine to assess the health of chronic disease patients who develop non-emergency health problems.

The pilot is viewed as a way to reduce costly hospital readmissions and unnecessary visits to emergency departments.

“When a patient is discharged from a hospital to home or long-term care facility and they have a chronic illness, many things can trigger a patient being sent back to the hospital,” said Greg Beauchemin, CEO of Community EMS.

“Some symptoms can be addressed by home health agencies. But after hours, they use an ambulance,” Beauchemin said.

Because the average cost of an ambulance run to a hospital is $3,700, Beauchemin said, Community EMS can make a house call for “one-tenth of that cost.” He said at least 50% of the ambulance runs in the city of Detroit’s Detroit EMS are unnecessary.

Under the mobile health initiative, Community EMS and its consulting firm subsidiary, Parastar, will send advanced practice paramedics to Botsford Continuing Care Center in Farmington Hills, Mich., to test its system on patients who have been screened by nurses and physicians, said Kevin Bersche, Parastar’s director of operations.

Bersche said the advanced practice paramedics will be in close contact with emergency physicians at Farmington Hills-based Botsford Hospital, which owns Community EMS and is collaborating on the initiative.

He said similar community paramedicine programs in Texas and Minnesota are showing promise.

“We want to legitimize that treatment can be done and that it does not jeopardize care,” said Bersche, who was deputy chief of the Farmington Hills Fire Department for 32 years before joining Parastar last June.

Sanford Vieder, D.O., Botsford’s ER director, said nurses at Botsford Continuing Care have been trained to determine when a patient needs an ambulance or could be served by the mobile health program.

“Based on our protocol, the nurses call a 1-800 number and a (Botsford) ER physician screens the call,” Vieder said. “We go through a series of questions and determine if a patient is a candidate. If we don’t think so, 911 is called.”

When paramedics arrive at nursing homes, Vieder said, they will help evaluate the patients and connect them to “VideoDoc” telemedicine devices provided by Wixom-based Health Net Connect, a subsidiary of J&B Medical Supply Co.

Health Net’s VideoDoc, which features high-definition cameras and two-way audio systems, allows physicians to remotely examine patients, talk with them and monitor vital signs.

“Under the supervision of a physician, paramedics will use VideoDoc to find out why (patients) are wheezing, coughing or having a problem,” Vieder said. “They will give antibiotics or steroids and treat them as needed. If they are not improving, they will be transported to the hospital.”

Beauchemin said the mobile health initiative will test the care of about 130 patients to determine if Parastar’s system reduces costs and protects patient safety.

“We will prove to payers (and the Centers for Medicare and Medicaid Services) that from a long-term perspective, patients are better off and costs are lower by treating (patients with non-emergency conditions) at home,” Beauchemin said.

Vieder said the problem is that Medicare and private payers don’t have a reimbursement code to pay for paramedic house calls or the use of telemedicine.

“We hope Medicare and payers adopt a shared savings model where the money saved by eliminating transport and treatment costs can be shared” with providers, Beauchemin said. The shared savings model could be a precursor to a formal reimbursement code, he said.

Bersche said Community EMS has applied for a $3.9 million CMS Innovation Center federal grant to fund the test program. If approved, the funds would help pay for the mobile health initiative, he said.

Vieder said elderly patients at nursing homes and residencies are often unnecessarily sent by ambulance to hospital emergency rooms when they have some sort of medical distress.

“If they have a medical problem, they frequently get put into a truck, brought to a chaotic ER, treated, then sent back to the nursing home,” Vieder said. “The benefit is not pulling them away from a comfortable environment they are in unless they have a real medical emergency.”

Vieder said many 911 ambulance calls are avoidable by assessing patients and providing at-home paramedic or nursing care.

Besides reducing unnecessary hospital readmissions or admissions, Bersche said, the project also could reduce ER utilization that could lower staffing costs.

At Botsford Hospital, for example, 26% of patients who enter the ER are admitted to the hospital. Of total hospital admissions, 70% come through the ER, Vieder said.

“There is no doubt that if we reduce the number of people coming into the ER, we would have fewer inappropriate hospital admissions and lower costs to the system,” he said.

Dr. Gregory Berger, executive medical director with Detroit Medical Center’s Michigan Pioneer ACO, said the Community EMS initiative is a promising method that can save money and improve quality.

“A lot of people end up at the hospital for many reasons,” Berger said. “There might be a social problem or a prescription or food program. The idea of getting extra eyes at the home is valuable.”

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