Home Health & Hospice Week

How will new trend affect traditional home health agencies, hospices?

Are home health agencies letting ambulance providers steal their thunder when it comes to partnering with hospitals for readmission prevention?

According to news reports across the country, ambulance companies are forging programs where they prevent ER visits and/or hospital readmissions by seeing patients in their homes for nonemergency medical visits.

Example #1: Medstar Ambulance Service and McLaren and Henry Ford Macomb hospitals in Detroit ran a trial Mobile Health Paramedic program from July to December, where paramedic crew visited patients shortly after hospital discharge to make sure they were following doctors’ instructions and to avoid readmission, reports The Detroit News.

Under the program, COPD and CHF patients released from the hospitals received daily home visits from Medstar paramedics for the first two weeks, then every other day for the rest of the month-long monitoring period. The hospitals and ambulance company didn’t charge the patients for the visits.

Similar programs are running in Michigan, according to the News. Community EMS in Southfield began a mobile health program with Botsford Hospital to have paramedics visit chronic disease patients to prevent hospitalizations. And Huron Valley Ambulance is testing a pilot program in Livingston County to determine whether ambulance runs could be replaced by paramedic visits for non-lifethreatening 911 calls.

Within a month of discharge, about 24 percent of the hospitals’ CHF and COPD patients return to the hospital with symptoms, according to Medstar CEO Kolby Miller, the majority due to the patients’ failure to follow up with their doctor. In contrast, “Since the program has started, we’ve had zero readmissions of the patients participating in the program,” Chris Starke, McLaren Macomb’s director of clinical organization effectiveness, told the newspaper in December.

Miller estimates the program could keep 180 patients from being re-admitted, saving $3 million annually between the two hospitals.

Example #2: Eagle County, Co., has a community paramedicine program going, and Aspen Ambulance plans to train its paramedics in a community paramedicine program this year, reports Aspen Public Radio.

“Many times a hospital is not the place that a patient should be transported to,” says paramedic and state senator Leroy Garcia, who hopes to grow community medicine programs across the state. “These are things that could be resolved through a health care provider coming to your home.”

These paramedicine programs aim services more at Medicaid beneficiaries who have trouble accessing routine care, and often end up in the hospital as a result, Aspen Public Radio points out.

Example #3: Ambulance providers are making inroads into hospice-related care as well. In Ventura County, Calif., American Medical Response manager Mike Taigman had heard of a Texas program where paramedics work with hospices to better honor a person’s end-of life wishes, reports KPCC Public Radio. The ambulance company pitched the idea to several local hospices, who were eager to try it.

The problem: A person’s end-of-life desires are most often thwarted when well-meaning loved ones see the patient in distress, says Teri Helton with Livingston Memorial VNA in Ventura. Instead of calling the hospice, they call 911.

That results in hospital care the patient doesn’t want, as well as potential hospital costs the hospice must cover.

The solution: Under the county’s pilot 911 hospice program, paramedics are trained to consult the hospice first to see whether the patient can be managed at home, as they wish.

“I was a little bit skeptical at first because for so many years I had been trained to treat and transport the patient,” Mike Sanders, a paramedic supervisor who received the hospice training, told the radio station. But “I’m able to treat somebody and put them in a position of comfort and contact the hospice provider and talk to the nurse or if the nurse is on scene consult with the nurse and the family and make a decision from there,” he says. “And nine times out of 10 we don’t end up needing to transport that patient.”

Under the program, paramedics can offer the patient medications that reduce pain, calm anxiety and ease labored breathing — all of which calms family members and, in turn, makes it easier for them to uphold the patient’s wishes to stay at home.

Before the pilot began Aug. 1, about 80 percent of the 911 calls in 2015 for hospice patients landed them in the hospital, KPCC says. From August to December, only about 25 percent of the calls resulted in a trip to the ER.

Program advocates argue that instead of taking money away from hospices, the program actually saves hospices money by averting unnecessary ER visits.