The Role of a Community Paramedic as a Provider in a Skilled Nursing Care Practice 2/24/2017

Presenters Michael Wilcox, M.D. Michael Wilcox M.D., FACEP, FAAFP mwilcox3090@yahoo.com 612-803-2912

Presenters Kai Hjermstad Kai Hjermstad NREMT-CP lhjermstad@aol.com 952-297-6742

Disclosures: None

Today’s Agenda Objectives Background of Skilled Nursing Facility patients (SNF) Caring for SNF patients Personal review of the CP at work Summary

Objectives After attending this presentation the participant will know: Types of patients who demand SNF care Reimbursement strategies for patient’s healthcare in SNFs How CP’s can assist in providing healthcare for patients who live in SNFs

Today’s Agenda Objectives Background of Skilled Nursing Facility patients (SNF) Caring for SNF patients Personal review of the CP at work Summary

Background Skilled Nursing Facility Patients 4 types of patients who reside in SNFs Transitional Care: These patients are admitted post-hospitalization for short courses of rehabilitation therapy: Focuses upon PT/OT/Speech Therapy LOS: 4-8 weeks Postoperative Management: THR, TKR, Upper extremity fracture care Orthopedic Care Post – Trauma care

Background Skilled Nursing Facility Patients Transitional Care Patient GI, GU, Neurological surgical care Postoperative gastric bypass care Complicated Medical Case Management: High- Risk medical recall patients Patients on 10+ medications Patients who have 3+ co-morbidities Patients on medications with a tight therapeutic window (Example-warfarin, digoxin, antiepileptics) Patients who have a significant mental health overlay

Background Skilled Nursing Facility Patients Transitional Care Patient Complicated Medical Case Management: Illnesses include: DM, CHF, COPD, Post-CVA, Chronic Pain Management, CD/Mental Health issues Numbers of these patients are increasing as our population ages By 2030, 30% of the US population will be 65 years or age or older

Background Skilled Nursing Facility Patients Transitional Care Patient Reimbursement for services is usually a government third-party based payer (Medicaid, Medicare) Payments are shifting from one of “fee-for-service” to one of “shared savings”

Background Skilled Nursing Facility Patients 4 types of patients who reside in SNFs Morbidly Obese: These patients are admitted with weights exceeding 350 lbs. These patients demand a high level of personal assistance (3:1 NA) Patients are classified under high-risk medical recall Reimbursement for services usually is a government based third-party payer Payments are shifting from one of “fee-for- service” to one of “shared savings”

Frail/Disabled: Mentally Ill: Background Skilled Nursing Facility Patients 4 types of patients who reside in SNFs Frail/Disabled: These patients are frequently elderly These patients frequently have several co- morbidities Patients demand close medical oversight 24/7 Reimbursement for services are usually as noted above Mentally Ill: Due to our aging population there is an increasing need to care for patients with dementia Reimbursement for services is usually as noted above

Today’s Agenda Objectives Background of Skilled Nursing Facility patients (SNF) Caring for SNF patients Personal review of the CP at work Summary

Caring for SNF patients LTC Group, PLLC Research has shown that there is a higher quality of care provided at a reduced cost if patients in SNFs are handled with a medical team Since 2010 the certified Community Paramedic (CP) by statute has been recognized as a physician extender in the provision of patient care within Minnesota To achieve certification by the Minnesota EMS-RB, as a CP, the Paramedic must complete a 14 credit course of study housed within an academic setting within MnSCU One organization that specializes in the provision of healthcare within SNF units has added the CP provider as a member of the team Long Term Care Professionals, PLLC

Long Term Care Professionals Dr. Michael Wilcox Dr. V. Simon Mittal The group came into existence in 2009 as a virtual clinic to provide healthcare to SNF patients Provides care in 20 SNF units within the greater Minneapolis/St. Paul area Provides direct patient care to 3,500 patients on an ongoing basis

Caring for SNF patients LTC Group, PLLC Last year there were 13,000 patient encounters provided Group is made up of 7 physicians, 4 Nurse Practioners, a Program Manager, a Facilities Manager, 4 Facility Liaisons and 4 CP’s added in 2016 Role of the CP to date: Completion of timely, ongoing medical reconciliation Interaction with staff to fine tune patient needs before the NP/MD visits the facility Assistance with call using protocols that have been developed by the Medical Director EMR used is eClinical Works

Today’s Agenda Objectives Background of Skilled Nursing Facility patients (SNF) Caring for SNF patients Personal review of the CP at work Summary

Personal review of the CP at work Kai Hjermstad, NREMT-CP Focus: Medication reconciliation Staff Liaison On call coverage

Today’s Agenda Objectives Background of Skilled Nursing Facility patients (SNF) Caring for SNF patients Personal review of the CP at work Summary

Summary As our population becomes older there will be an increased need for provision of SNF care Third party payers will focus upon reimbursement strategies that reward community care and penalize recurrent admissions for hospital care Properly educated certified CP’s will become valuable members of the healthcare team CP providers will play a major role in future SNF healthcare programs promoting technology and bedside patient assessment tools

Questions? Michael Wilcox M.D., FACEP, FAAFP mwilcox3090@yahoo.com 612-803-2912 Kai Hjermstad NREMT-CP lhjermstad@aol.com 952-297-6742