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On Tuesday, April 28, more than 200 EMS leaders gathered in Arlington, VA, for EMS World’s Mobile Integrated Healthcare Summit, held in conjunction with the National Association of Emergency Medical Technicians’ EMS On The Hill Day.
The audience heard from several leaders and innovators discussing topics such as the need for reimbursement reform in EMS, how to fund MIH-CP programs and how to measure program performance. The highlight of the program came when agency representatives from a diverse group of EMS providers described how they established MIH-CP programs and what lessons they learned along the way. One of those programs included the Dallas Fire-Rescue Department Mobile Community Healthcare Program.
Dallas recently completed the first year of its program, which aims to reduce 9-1-1 calls for EMS services among the most frequent users. According to Dallas Fire-Rescue Assistant Chief Norman Seals, a panelist at the MIH Summit, the program exceeded expectations during its first year.
“We’ve seen an 83.5% reduction in their 9-1-1 utilization over a year’s time,” Seals said of the 73 patients enrolled in the program. “We’re monitoring them one year post-graduation or removal from the program, and it’s sticking. It’s working.”
Seals shared some lessons learned during the development and implementation of Dallas’s program, several of which were reiterated by other speakers throughout the day.
Empower the Team
One of the keys to Dallas’ success, Seals says, has been the autonomy given to the group of paramedics chosen to plan, implement and staff the Mobile Community Healthcare Program (MCHP).
“One of the most critical parts in doing one of these programs is you choose the right people, you train and educate them to the best extent possible, and then you empower them to make it their own program,” says Seals. In Dallas, department leaders chose five paramedics out of many who applied for the program; Seals described them as enthusiastic volunteers, some who nearly cried tears of joy when they were selected to be a part of the new initiative.
“They are invested wholeheartedly in this project and they love what they’re doing,” says Seals.
Not only did Dallas carefully select who would be a part of the MCHP team, the agency also gave those paramedics several months to learn about healthcare reform, MIH-CP programs, city resources and other critical pieces of putting a program together. The fire department then took its time putting together a program instead of rushing to start.
Learn Case Management
Many of the presenters at the MIH Summit discussed the importance of learning case management in order to find the best solutions for frequent utilizers’ problems.
“It’s not necessarily what we in the fire service or EMS as a whole do,” says Seals, explaining that case management is in some ways the antithesis of the traditional EMS model of rapid response and rapid transport. Mobile integrated health uses “completely different concepts” than fire departments are used to, adds Seals.
Find Community Partners
To learn the case management process in Dallas, the MCHP team reached out to people with experience who could teach the paramedics and help the team manage its patients. This was just one example of how Dallas Fire-Rescue reached out to community partners during the development and implementation of its program.
“Our network has grown exponentially,” says Seals. “It’s amazing to see the community respond to what we’re doing.”
Other speakers at the summit shared similar stories about discovering organizations in the community that provided services that their patients needed. By continuously attending meetings and discussing their MIH-CP programs, they successfully expanded their networks and found new partners.
“What we found in Dallas is that we have this huge number of resources that are available to help these people. There are hundreds of organizations,” says Seals. “Yet there’s been a huge gulf between [the organizations and the people who need their services]. Somehow these people fall through the cracks. We’re helping to bridge that chasm that lies between the two.”
Active Medical Direction
In addition to connecting with a network of city and community resources, the paramedics in Dallas also benefited from the support and advice of a medical director who was—and is—intensely involved in the program. Marshal Isaacs, MD, FACEP, has been actively advising the team, helping them create plans for patients and helping Seals communicate with the rest of the medical community.
“I had to learn a new language. [Hospital administrators] speak a different language than firefighters,” says Seals, crediting Isaacs with teaching him how to talk to hospital leaders, advising the audience that the medical director should be “by your side every step of the way guiding and directing what you’re trying to do.”
Involve the Legal Team Early
Although the Dallas MCHP team has received strong support from city leaders, Seals recognized the importance of transitioning from a program subsidized by the fire department’s budget to one that is sustainable. “Very early on, [the city manager] said ‘It sounds like a very good idea, we’ll fund it for a little while, but’—and y’all know what comes next—‘you’d better make it pay for itself as quickly as possible,’” says Seals.
Part of that process has involved negotiating contracts with hospitals—Seals said the department is close to inking its first deal. “Half a dozen hospitals right now are begging for a draft contract. They want to put money in my hand,” he said.
But Seals said the “biggest hurdle to date” has been educating the city attorneys. He advised others to bring their legal teams in during the early stages of planning, both to get their counsel on issues and to give them time to learn the aspects of healthcare law they may not be familiar with.
“Municipal attorneys are not specialists,” he says, “so they’re going to have to wrap their head around a whole new set of requirements.”
Despite some of the obstacles they’ve faced, Seals was optimistic about the future of the Dallas program, saying they hope to expand it beyond the five paramedics currently seeing patients.
“I could easily see in a few years’ time having 40 or 50 paramedics in our program and a whole command structure,” he says, adding that the program presented an opportunity to make a difference in people’s lives unlike anything he’d done in the fire department before. “I’ve been doing this job for nearly 30 years and this is by far the coolest thing I’ve ever been involved in.”
Michael Gerber, MPH, NRP, is an instructor, author and consultant in Washington, DC. He is also a paramedic with the Bethesda-Chevy Chase Rescue Squad and previously worked as an EMS supervisor for the Alexandria (VA) Fire Department. Gerber has experience as an EMS educator and quality management coordinator and has presented original research at state and national EMS conferences. Reach him at firstname.lastname@example.org.