April 21--CHESAPEAKE -- Paramedics sometimes refer to them as "frequent fliers" -- habitual callers to 911 who require a trip to the emergency room even though they're not in an emergency medical crisis.
Some are substance abusers. Others might suffer from mental disorders, or are unable to manage their medications and become ill.
Yet emergency medical personnel responding to such calls say they have no choice but to transport repeat customers to the hospital, where they are checked over and sent home, often untreated, at a substantial cost to taxpayers and the health care system.
Thomas Schwalenberg, chief medical officer in the Chesapeake Fire Department, is convinced there must be a better way.
"It's not good for the patient or the hospital," Schwalenberg said. "And it's certainly not the most efficient use of our personnel."
He and his department are looking at a possible solution: enlisting the city's paramedics in a community-health outreach program known as Mobile Integrated Healthcare.
Some 232 fire departments around the country have adopted the program aimed at reducing unnecessary ambulance runs and matching patients with appropriate care.
While programs differ from place to place, a common feature uses specially trained paramedics to make in-home visits to chronic 911 callers and others needing help lining up care.
Patients might be referred to alcohol or drug treatment centers or acute-care facilities. Others receive counseling or other services to help them maintain their health.
The city is about to begin a $75,000 feasibility study to determine if it is a good fit here.
"This is not something EMS can do alone," Schwalenberg said. "We have to partner with the hospitals, physicians' offices, mental health, hospice services. It's a process that looks for a better way to provide patients the service they need without taking them to the most expensive place to get care, which is the emergency department."
In Wake County, N.C., EMS personnel noticed a big drop in "chronic callers" to 911 after it launched a Mobile Integrated Care program in 2009.
Jeffrey Hammerstein, chief of community outreach for the county's Emergency Medical Services, said by referring or redirecting patients to "alternative destinations," the program "helped free up 3,528 hours in crowded emergency departments in a one-year period... making more space for 1,176 chest pain patients."
He cited the case of a 50-year-old alcoholic homeless man in downtown Raleigh who called 911 for nonemergency care more than a hundred times in 2011 and 2012. Paramedics intervened, and he was admitted to an alcohol treatment facility and counseling center.
By 2013, Hammerstein said, he was "discharged, clean and living with his family" and the 911 calls stopped. "That's good for the system, but that's great for him."
Portsmouth recently began a small-scale version of the program as part of a community-wide emphasis on improved health, according to Jeffrey Meyer, the city's EMS director.
It has two people assigned to the program who work with a handful of patients with chronic illnesses, making sure they take their medications properly.
"So far, it's been well-received," Meyer said.
Part of the impetus for Chesapeake, Schwalenberg said, is uncertainty over the future of fee-based services under the Affordable Care Act.
His department makes about 25,000 ambulance runs per year. Some 15,500 of those involve transporting a patient to the hospital. The cost, based on national averages, is about $415 per run.
The city submits reimbursement requests to Medicare, Medicaid or private insurers, and "we take what they will pay. We don't argue," Schwalenberg said.
"But that model of payment -- fee for service -- is going away. When that happens, how do we continue to provide the service we provide?"
Jeff Sheler, 757-222-5207, [email protected]
Posted to: Chesapeake Health Local Government News
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