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Fire-Based EMS The Next Generation
Fire Chief Harry Beck Mesa Fire and Medical Department Gary Smith, MD Medical Director, Mesa Fire and Medical Department
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Purpose Describe a model of Fire-Based EMS for proven performance and efficiencies under the Affordable Care Act.
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City of Mesa, Arizona 137 square miles 75,000+ > 62 years of age
440,000 residents (2010) 85,000 winter visitors (2010) 75,000+ > 62 years of age Diverse Population
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Mesa Fire and Medical Department
21 ALS Engines 5 ALS Ladders Community Paramedics Private Ambulance 2 Community Care Units 20 Fire Stations 55,938 Total Calls 80 % Fire Based EMS
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Mesa Fire and Medical Dispatch Analysis 2013
Mesa 911 Calls 55,938 Medical Emergency Calls 45,854 Low Acuity Calls 10,061
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Community Care Initiative
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Low Emergency Response Model Features
Improves Availability for Response to High Emergencies Improves Availability of Ambulances and ERs 911 Based Operated from Fire and Medical Response Model Integrates Partnerships
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Low Emergency Response Model Features
Allows Partner Billing No City Billing at This Time No change in PM Scope of Practice Tiered Triage and Deployment Alternate Destination/Admission Avoidance PCP Referral
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Community Paramedic Unit (TRV)
Captain Paramedic & Firefighter Two Response Units Low Acuity Patients Peak Time Deployment Priority Dispatch Triage Treat and Refer
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Community Care Nurse Practitioner Unit
Captain Paramedic & Nurse Practitioner Nurse Practitioner Provided by Mountain Vista Hospital Treat and Refer to PCP CLIA Waived Laboratory Tests Provide Alternative Destination Patient Follow-up Peak Time Deployment Provide Support to Law Enforcement
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Community Care Behavioral Health Unit
Captain Paramedic and Behavioral Health Specialist Dispatch to Definitive Care in 1-Hour 45-Minutes Alternate Destination Video
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Proven Model Air Date: January 2013, KSAZ-TV
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Emergency Room Costs 2013 Cost Comparison
Source: Kliff,S. An Average Emergency Department Visit Costs More Than an Average Month’s Rent. The Washington Post. 2 March 2013
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Emergency Care Charges Low Acuity Medical Patients
Past Model New Model Savings Transport to ER $1,000 $0 $1,000 Registration $525 $0 $525 Physician Assessment $325 $150 $175 Decision Making $950 $0 $950 MFMD Cost $375 $375 $0 $2,650 Total Savings per Patient
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Emergency Care Charges Behavioral Health Patients
Past Model New Model Savings Transport to ER $1,000 $0 $1,000 Initial Evaluation $3,500 $150 $3,350 3-Day ER Hold $6,000 $0 $6,000 Inter-Facility Transport $1,000 $0 $1,000 MFMD Cost $375 $375 $0 $11,350 Total Savings per Patient
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Unit Insurance Coverage
2013 Community Care Response Behavioral Health Community Care Response Behavioral Health Medicare 28% 44% Medicaid 37% 36% Private 15% 19% None 20% 1%
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Projected Cost vs. Benefit Detail
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EMS Prevention Model Features
Reduces EMS Calls Supported by Call Center RN Tiered Triage Coordinates with Providers Integrates Partnerships
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EMS Prevention Model Features
Incorporates City Billing Assists with Sustainability Provides Post-Hospital Services Provides “GAP” Services Reduces Hospital Admissions
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Loyalty Customer Program
Proactive Service Reduction of EMS Calls Partnership with ACO
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Transitional Care Program
72-Hour Post-Discharge Contact Partnership with Physician (PCP/Specialist) Proactive Service Reduces Readmissions Transition to Home Health Sustainable
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Hospice Comfort Pack Program
Coordinated with Hospice Provider Maintains Patient Qualification Improves/Maintains Care Eliminates Transport Sustainable
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Crisis Prevention Outreach Programs
Target Populations Facilitates Access to Appropriate Service Facilitates Intervention Behavioral Health Partnership
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Community Based EMS Programs
Direct Community Involvement Partnership with Good Samaritans Awareness/Education/Training MICR/CPR Training First Aid Training Hospital Partnerships Immunizations School Partnerships
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What… When… Where… Why…
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The Reason We Are Still Needed
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…and Needed Less
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The Fire Service is Getting More Expensive…
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Mobile Integrated Healthcare Programs
Pilot programs focus on Patient Navigation 9-1-1 Nurse Triage “EMS Loyalty” Programs Readmission Avoidance Hospice Revocation Avoidance 23-hour Observation Avoidance Require Agility
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Core Reform Strategies
Public Reporting: engaging consumers and other stakeholders Health Information Technology: enabling improvement Value-Based Payment: rewarding achievement Clinically Integrated Delivery Systems: achieving patient centered care
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A Future System Affordable Accessible – to care and to information
Seamless and Coordinated High Quality – timely, equitable, safe Person and Family-Centered Supportive of Clinicians in serving their patients’ needs Engaged with the community and fulfilling its population’s unique needs
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Developmental Needs Cost Recovery Shared Savings Pay-For-Performance
Capitation ACO Involvement Fire Station Based Clinics 72 hr. Patient Follow-Ups Research Evidenced-Based Quality Assurance
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To view a copy of this presentation…
Find us: mesafiredept East Valley Wellness AZ
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Mountain Vista Medical Center
Public-Private Partnership Mountain Vista Medical Center IASIS Healthcare (One of the largest healthcare organizations in the US) 176 Beds 15 Bed Emergency Department 55,000 ED visits a year Level 3 Trauma, Stroke Center, Cardiac Center
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Mesa Fire and Medical Model
Evolving Issues National Health Care Major Issue Cost of Health Care % GDP Impact of Affordable Care Act Resulting Changes to CMS Creation of Accountable Care Organizations CMS Grant Opportunity
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Community Care Initiative: Aims and Drivers
Affordable Care Act Community Care Initiative: Aims and Drivers
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Dispatch to Definitive Care
Behavioral Health Dispatch to Definitive Care in 1 hr 45 min Video
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Citywide BLS Calls 2013
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Behavioral Health/Substance Abuse
2013
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Behavioral Health/Suicide Threat
2013
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2012/13 Community Care Response Pilot
Community Care Response Unit 2012/13 Community Care Response Pilot 2012/13 CCR Responses 1,250 Directed to Appropriate Care (40%) 2012/13 Low Acuity Response Analysis (based on current dispatch protocols) Medicaid 3,723 Medicare 2,817 Private ,509 Uninsured 2,012 Directed to Appropriate Care (potential) 4,024
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Cost Average Per Patient Total $375 Human Resource Supplies/Equipment
Community Care Response Unit Cost Human Resource Captain Paramedic and Nurse Practitioner or Behavioral Specialist) $310 Supplies/Equipment $20 Response Apparatus $45 Average Per Patient Total $375
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Medicare 18% Medicaid 15% Private 8% None 1% No Information 59%
Behavioral Health Unit Insurance Coverage Including Patients with no Insurance Information 2013 Medicare 18% Medicaid 15% Private 8% None 1% No Information 59%
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Behavioral Health Unit Insurance Coverage
2013 Medicare 44% Medicaid 36% Private 19% None 1%
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Private 23% Medicare 3% Uninsured 29%
Billing Information for Behavioral Health Unit Information Provided by the Mental Health Provider 2013 Private % Medicare % Uninsured % Medicaid/Medicare/Magellan 45%
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Community Care Response Unit
Expansion of the model Public-Private Partnerships Higher Education for Members Enhance public access Fire Station Based Clinics Determine demographics
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The Next Generation Public School Partnerships Communication Center
Centralized Medical Direction On site medical direction Telemedicine Business/Special Events Integrate into health care systems
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The Next Generation Post Surgical Checks Injury Prevention
Community Based EMS Behavioral Health Intervention Sustainability Healthcare Information Exchange
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Primary Care Physician
Not to replace the Primary Care Physician
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