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Eagle County, Colo., to practice preventative EMS
By Steven K. Paulson
DENVER — A select group of paramedics in several states is helping to provide primary health care by making house calls — an initiative encouraged by the federal health care law to address shortages in primary care and cut down on expensive visits to doctors and emergency rooms.
In Colorado's Eagle County, paramedic Kevin Creek makes house calls to take electrocardiograms, check patient prescriptions, check blood pressure, change dressings, draw blood and make other observations that used to require a doctor's visit.
"We all get into this because of the adrenaline rush," Creek said of his career as a paramedic. "I've done the car accidents. I've done the shootings and the stabbings. Instead of taking out the blood and guts, this is a move into preventative care, so people don't have to call 911."
Creek and a colleague participating in the pilot project through the Western Eagle County Ambulance District work full time under the supervision of doctors who refer them to patients. The doctors evaluate information provided by the paramedics and decide the next steps of care.
The Community Paramedic Program is free for anyone in Eagle County, which has an uninsured rate of 26 percent. But it is funded so far by $700,000 in grants from the Colorado health department, two private health organizations and the ambulance district, said district program coordinator Lisa Ward.
"We're the eyes and ears of the primary care physician in the home," said Ward. "It's out-of-the-box health care, and it's the future."
Colorado approved the five-year pilot program to determine how much money the state and federal government might save in Medicare and Medicaid spending in the county, which has a population of about 52,000, many of them in rural areas.
"We are so far away from a hospital and it's always hard to make that decision about whether to go," said Dr. Angela Ammon, one of the doctors who refers patients to the program. "Sometimes to bring patients back the next day (after a doctor's visit or being released from the hospital) would be a nightmare."
Health care providers are optimistic.
Tracy Hofeditz, a board member of the Colorado Academy of Family Physicians, said more than 600,000 people who are uninsured in Colorado could benefit from such a program without sacrificing the effectiveness of emergency responders.
Randy Kuykendall, president of the National Association of EMS Officials, said the recently passed federal health care plan calls for demonstration projects for innovative primary care.
"We assume emergency medical services can take care of some of that,'" Kuykendall said.
In Fort Worth, Texas, Dr. Jeffrey Beeson, past president of the American College of Emergency Physicians, said allowing paramedics to visit patients can reduce the number of ambulance calls. He said local paramedics who normally would have spent downtime waiting for such calls have used that time to visit more than 200 patients over the past two years.
Dr. Michael Wilcox, of New Prague, Minn., runs a similar program that has treated more than 400 patients since 2008. He said paramedics there have been doing the work for free but that he hopes the federal government will pick up the tab — if the program proves it can save money.
Most patients in New Prague are indigent or elderly patients who can't afford to go to a doctor for routine or preventive care, Wilcox said.
Participating paramedics, he said, are trained to assist with the management of chronic illnesses. "They can do lab work, vaccines and blood studies, all under the direction of a medical doctor," Wilcox said.
Wilcox said he's had inquiries from other states, including Maine, North Carolina, South Carolina, Wyoming and Nebraska.
In Colorado, Eagle County health officer Drew Werner said he hopes a successful pilot program can persuade insurance companies, Medicare and Medicaid to pick up the tab when the grant ends.
Jennifer Hefferan, of Eagle, credits a scheduled follow-up visit by paramedics for saving her daughter, Danielle.
She had been hospitalized last year for heart and breathing problems. At home, Danielle had difficulty breathing, her mother said.
"I couldn't tell if she was better or worse from the day before. She looked the same to me," Jennifer Hefferan said. "After the paramedics came, the doctor called back and said she needed to see her right away."