Eli's Hospice Insider

Can paramedics help keep hospice patients out of the ER?

Hospices looking for ways to reduce their costs and build better relationships with their hospital referral partners may want to research “community parademic” programs.

Programs in Ventura, Calif., Fort Worth, Texas, and New York City are seeing success in keeping hospice patients out of the emergency room and hospital at end of life, reports a Kaiser Health News story that ran in the Dallas Morning News. The result: lower costs for hospices, prevention of hospital readmissions (and associated financial and quality penalties), and patients who are able to follow through on their wishes to remain at home at end of life.

How it works: In Fort Worth, VITAS pays Medstar Mobile Healthcare a set fee per hospice patient who has been flagged in the hospice admissions process as likely to call 911 or end up in the hospital, the News reports. When a hospice patient calls 911, the community paramedic is dispatched along with the regular paramedics to offer in-home support and services in hopes of averting an ER visit and hospitalization.

In California, the program run through a state agency works with 20 hospices and sends a community paramedic to any 911 call involving a hospice patient.

Under a grant in New York, Long Island based Northwell Health system gives its hospice patients in Queens a 24/7 hospice number — when a patient calls, a community paramedic can be immediately sent, the News says.

VITAS stresses to caregivers that a hospice nurse is available around-the-clock, but family members may not feel they can wait for a nurse who might have to drive from an hour away, says VITAS’ John Mezo. “If you’ve ever had to call 911, even five minutes waiting on an ambulance seems like an eternity, right?”

Only 20 percent of patients in the first five years of the Fort Worth program ended up going to the ER, the News report. Ambulance transports for hospice patients calling 911 declined in Ventura as well — from 80 percent shortly before the program’s start to 37 percent from August 2015 through December 2016.