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Benefits of Community Paramedicine for Rural Community Health Communities have started to examine the best ways to use their emergency medical services (EMS) resources efficiently. Community paramedicine programs are one innovation that can particularly benefit rural populations because many people in rural communities have limited access to other types of healthcare. These programs are designed to supplement existing primary care, the public health infrastructure, and fill existing service gaps. Community paramedicine services can help their communities by: Reducing the burden on other providers. By treating patients in their homes or other locations outside the clinic, community paramedics reduce the number of patients in hospital beds, nursing homes, or emergency rooms. Reducing unnecessary transports. In some situations, community paramedics can provide the appropriate level of care to individuals who call for help with non-emergent issues. For example, a community paramedic could assess and treat a patient who had a minor fall in their home and determine whether or not additional care and transportation to the hospital are needed. Increasing access to primary care. Through home visits, community paramedics can provide traditional primary care services to patients. These can include routine vaccinations; wound care; or checkups for patients with high blood pressure, diabetes, or other chronic conditions. Programs may also help fill the needs of uninsured or underinsured patients who are otherwise unable to access services from home health agencies. Improving quality of life. Through increased access to care, community paramedics provide individuals with services like home modifications that will improve patient quality of life and potentially allow them to stay independent in their own home for longer. Supporting mobile integrated healthcare. Because community paramedics have already established relationships with healthcare providers outside of EMS, their role can bridge gaps between existing services and bring those services out into the community Populations that May Benefit from Community Paramedicine Programs Community paramedicine programs can increase access to primary care services for people living in medically underserved areas, people with limited mobility, and people who can benefit from increased care coordination. This section highlights specific populations that could benefit from this increased level of care. These populations include: People Living with Chronic Diseases Chronic disease is a significant cause of disability and poor health in rural areas, where about 28% of residents had at least two chronic conditions in 2016. Many of these patients with chronic diseases are older adults (aged 65 and older). For people who have multiple chronic conditions or conditions that are difficult to manage, they may rely on emergency services when they are experiencing challenges that could be addressed through primary care services like medication management. Community paramedicine programs can provide mobile, non-emergency care to fill that gap. For example, in a study from Regions Hospital in Minnesota, community paramedics helped patients with diabetes and hypertension reduce their blood pressure and blood sugar. Through this program, 62% of patients saw decreased blood pressure levels and 78% of patients saw decreased blood sugar levels. Homebound Patients Community paramedicine programs involve community paramedics traveling within their communities to provide care in a way that is convenient for patients. Trained paramedics are able to visit these homebound patients and provide them with medical care, without needing to immediately transport them to the emergency room for services that may be more intensive, costly, or complex than needed. For example, the Minnesota Department of Health highlights how community paramedics could help patients with their medical equipment. If it is within their program's practice guidelines, community paramedics can also provide palliative or hospice care, when appropriate. Frequent Users of 911 with Non-Emergent Needs individuals who need services other than emergency medical care. These may be people with complex medical or mental health conditions who would benefit from care coordination, behavioral health, or primary care services. Community paramedics can help frequent 911 callers with non-emergent needs by connecting them with appropriate health or social services, which can lead to a decrease in the number of emergency calls. Frail or Older Adults Older adults and individuals in frail physical condition may not be able to access proper healthcare and may live in homes that are not properly equipped to minimize fall or injury risk. A case study in Nebraska describes a community paramedicine program that provides assistance to these populations by performing home safety inspections, during which paramedics install smoke alarms and support bars so residents can more easily navigate through their homes. Additionally, community paramedics can support medication compliance for these populations and help families identify patients who would be best served in a nursing home or assisted living environment. Patients Recently Discharged from the Hospital The Center for Healthcare Quality and Payment Reform reports that within 30 days of discharge, 15% to 25% of patients are readmitted to the hospital. Preventable readmissions of patients recently discharged from the hospital cost the U.S. healthcare system $41.3 billion in 2011, according to the California Health Care Foundation. Some of these readmissions are due to a lack of understanding by the patient or clear instruction from the hospital about how to transition to appropriately caring for their condition on their own, which can be addressed with the help of a community paramedic. Community paramedics can visit the patient's home and schedule follow-up calls and visits to the patient while they are transitioning back to their life at home. The community paramedic can help with adherence to the discharge information, medication management, and scheduling follow-up appointments. Barriers to Establishing Community Paramedicine Programs in Rural Areas Rural emergency medical services (EMS) and community health programs may experience some challenges when trying to establish a community paramedicine program in their jurisdiction. For more information about identifying and addressing barriers to implementation, please see Module 4: Implementation Considerations. Funding/reimbursement. As described by the American Academy of Home Care Medicine, payers do not typically reimburse costs related to EMS, including ambulance rides, unless the patient is transported to an emergency department. Because community paramedicine programs are designed to limit the number of unnecessary transports, this means that many of their services may not be reimbursed under traditional payment models. Many programs are currently funded through in-kind or financial support from ambulance services, hospitals, or grants. However, EMS World reports that payers are beginning to recognize the savings that community paramedicine programs can provide. For example, Accountable Care Organizations (ACOs), which are coordinated healthcare teams that incentivize providing comprehensive care for Medicare patients through value-based payment models, are now promoting community paramedicine programs. Some private insurers are also starting to consider providing reimbursement for EMS care services, even when the patient is not transported during the encounter. Electronic health records. Rural or resource-limited communities are less likely than urban health systems to maintain comprehensive electronic health records. These electronic modes of collecting patient data are helpful for communicating patient information with additional healthcare services and providers (also called interoperability) to support a coordinated care health services model. An integrated health records system can also help agencies track outcomes for their clients. This is valuable for demonstrating program effectiveness and identifying clients who may need additional assistance. Statutory barriers. In some states, paramedics are only allowed to respond to emergency calls and provide medical services as a first responder. Because of this and other scope of practice regulations, state and local jurisdictions may experience difficulty establishing a community paramedicine program, according to the Association of State and Territorial Health Officials. Some states, like Minnesota and Wisconsin, have passed legislation that can support the establishment of community paramedicine programs. Concerns about duplication of services. Some roles and responsibilities filled by community paramedicine programs may overlap with the activities of existing home health/home visiting services or community health worker programs. However, each jurisdiction can consider which types of community paramedicine services would be the most important to fill the existing gaps. Community paramedicine programs are not “one size fits all.”