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

2. Presenters Michael Wilcox, M.D.
Michael Wilcox M.D., FACEP, FAAFP

3. Presenters Kai Hjermstad
Kai Hjermstad NREMT-CP

4. Disclosures: None

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

6. 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

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

8. 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

9. 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

10. 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

11. 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”

12. 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”

13. 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

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

15. 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

16. 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

17. 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

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

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

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

21. 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

22. Questions? Michael Wilcox M.D., FACEP, FAAFP mwilcox3090@yahoo.com
Kai Hjermstad NREMT-CP