It is a common understanding that everyone deserves emergency care and access to a primary care physician to address chronic conditions. However, the current resources do not support this inalienable right. Instead, hospitals are constantly on overflow or high volume alerts, emergency departments are flooded with repeat patients and those who do not have primary care providers and insurance companies are continuing to pull back on paying for any of these mentioned services. To that end, finding ways to give every patient the care they need despite minimal resources or lack of financial compensation is becoming more and more difficult.
In recent years, the mission has been to find ways to overcome these struggles. Namely, institutions have been in search of answers to the questions: how does the healthcare system provide for all types of patients? How do hospitals avoid readmissions, and how can overuse of the emergency department by those solely requiring primary care be discouraged? The answer may lie in targeted patient follow-ups.
Targeted Patient Follow-ups
Targeted patient follow-ups are what they sound like: follow-ups for patients that may be at risk, those expected to require continued care or additional check-ups. Readmissions, although dropping since the Hospital Readmissions Reduction Program began in October 2012, are still plaguing many facilities, and this readmission places a burden on the hospitals in terms of resources. Not only are hospitals having to repeat cares for a patient, but they may even be missing out on revenue: penalties of up to 3% can be incurred, depending on Medicare’s assessment of the readmission circumstances. To avoid such readmission, then, focus needs to be placed on preventing readmissions in the first place.
If the level of suspicion is high that the patient may need further follow-ups (in situations involving patients living alone, post-surgical wounds that require monitoring or daily cares, at-risk individuals, and so forth), special care should be taken to arrange for follow-ups outside the hospital. Some EMS agencies are already starting to partner with hospitals to proactively identify and visit these high-risk patients. Part of the Community Paramedicine (CP) initiative, EMS agencies are slowly becoming front-line managers of follow-up care.
Community Paramedicine, a newer form of pre-hospital care that expands a paramedic’s scope of practice and places them in a nontraditional primary care role, has been showing great success in the areas it has been implemented. In January of 2017, California launched five pilot projects in which hospitals teamed with CPs to provide recently discharged patients with timely follow-up visits, calls, or both. As a result, hospital readmissions declined at all except one pilot site. Further, four of the five pilot sites saw significant cost savings for payers thanks to the reduced 30-day readmissions.
When it comes to CP, hospitals foot the bill, in most cases, for paramedics to visit patients and ensure prescription compliance, continued wound care and so forth. Equipped with a different set of tools and protocols, community paramedics not only use their judgement to determine if readmission is required, but they also get to establish professional relationships with their patients. Patients receive one-on-one care and attention by these medics, which in turn fosters improved safety, trust, care satisfaction and better overall maintenance of health.
Aside from giving patients a better experience and promoting improved, continued health, follow-ups can prove financially beneficial as well. Although it should not be the sole focus when it comes to medicine, money does play a large factor in society and cannot be ignored as a driving principal that governs many agency or hospital policies. With follow-ups, the need to maintain financial stability is addressed. Hospitals avoid readmission fees and EMS services garner slight revenue from the hospitals who are paying them to, essentially, keep patients healthy within their own homes.