Fire Chief Harry Beck Mesa Fire and Medical Department Gary Smith, MD

1. Fire-Based EMS The Next Generation Fire Chief Harry Beck Mesa Fire and Medical Department Gary Smith, MD Medical Director, Mesa Fire and Medical Department

2. Purpose Describe a model of Fire-Based EMS for proven performance and efficiencies under the Affordable Care Act.

3. City of Mesa, Arizona • 137 square miles • 440,000 residents (2010) • 85,000 winter visitors (2010) • 75,000+ > 62 years of age • Diverse Population

4. Mesa Fire and Medical Department • 2 Community Care Units • 20 Fire Stations • 55,938 Total Calls • 80 % Fire Based EMS 21 ALS Engines 5 ALS Ladders Community Paramedics Private Ambulance

5. Mesa Fire and Medical Dispatch Analysis2013 Mesa 911 Calls 55,938 Medical Emergency Calls 45,854 Low Acuity Calls 10,061

6. Community Care Initiative

7. Low Emergency Response Model Features • Improves Availability for Response to High Emergencies • Improves Availability of Ambulances and ERs • 911 Based • Operated from Fire and Medical Response Model • Integrates Partnerships

8. Low Emergency Response Model Features • Allows Partner Billing • No City Billing at This Time • No change in PM Scope of Practice • Tiered Triage and Deployment • Alternate Destination/Admission Avoidance • PCP Referral

9. Community Paramedic Unit (TRV) Captain Paramedic & Firefighter Two Response Units Low Acuity Patients Peak Time Deployment Priority Dispatch Triage Treat and Refer

10. Captain Paramedic & Nurse Practitioner • Nurse Practitioner Provided by Mountain Vista Hospital • Treat and Refer to PCP • CLIA Waived Laboratory Tests • Provide Alternative Destination • Patient Follow-up • Peak Time Deployment • Provide Support to Law Enforcement Community Care Nurse Practitioner Unit

11. Community Care Behavioral Health Unit • Captain Paramedic and Behavioral Health Specialist • Dispatch to Definitive Care in 1-Hour 45-Minutes • Alternate Destination Video

12. Proven Model Air Date: January 2013, KSAZ-TV

13. Cost Comparison Emergency Room Costs 2013 Source: Kliff,S. An Average Emergency Department Visit Costs More Than an Average Month’s Rent. The Washington Post. 2 March 2013

14. Emergency Care Charges Low Acuity Medical Patients Savings Past Model New Model Transport to ER $1,000 $0 $1,000 Registration $525 $0 $525 Physician Assessment $325 $150 $175 Decision Making $950 $0 $950 MFMD Cost $375 $375 $0 $2,650 Total Savings per Patient

15. Emergency Care ChargesBehavioral Health Patients Savings Past Model New Model Transport to ER $1,000 $0 $1,000 Initial Evaluation $3,500 $150 $3,350 3-Day ER Hold $6,000 $0 $6,000 Inter-Facility Transport$1,000 $0 $1,000 MFMD Cost $375 $375 $0 $11,350 Total Savings per Patient

16. Unit Insurance Coverage 2013 Behavioral Health Community Care Response Community Care Response Behavioral Health Medicare 28% 44% Medicaid 37% 36% Private 15% 19% None 20% 1%

17. Projected Cost vs. Benefit Detail

18. EMS Prevention Model Features • Reduces EMS Calls • Supported by Call Center • RN Tiered Triage • Coordinates with Providers • Integrates Partnerships

19. EMS Prevention Model Features • Incorporates City Billing • Assists with Sustainability • Provides Post-Hospital Services • Provides “GAP” Services • Reduces Hospital Admissions

20. Loyalty Customer Program • Proactive Service • Reduction of EMS Calls • Partnership with ACO

21. Transitional Care Program • 72-Hour Post-Discharge Contact • Partnership with Physician (PCP/Specialist) • Proactive Service • Reduces Readmissions • Transition to Home Health • Sustainable

22. Hospice Comfort Pack Program • Coordinated with Hospice Provider • Maintains Patient Qualification • Improves/Maintains Care • Eliminates Transport • Sustainable

23. Crisis Prevention Outreach Programs • Target Populations • Facilitates Access to Appropriate Service • Facilitates Intervention • Behavioral Health Partnership

24. Community Based EMS Programs • Direct Community Involvement • Partnership with Good Samaritans • Awareness/Education/Training • MICR/CPR Training • First Aid Training • Hospital Partnerships • Immunizations • School Partnerships

25. What… When… Where… Why…

26. The Reason We Are Still Needed

27. …and Needed Less

28. The Fire Service is Getting More Expensive…

31. Mobile Integrated Healthcare Programs • Pilot programs focus on Patient Navigation • 9-1-1 Nurse Triage • “EMS Loyalty” Programs • Readmission Avoidance • Hospice Revocation Avoidance • 23-hour Observation Avoidance Require Agility

32. Core Reform Strategies • Public Reporting: engaging consumers and other stakeholders • Health Information Technology: enabling improvement • Value-Based Payment: rewarding achievement • Clinically Integrated Delivery Systems: achieving patient centered care

33. A Future System • Affordable • Accessible – to care and to information • Seamless and Coordinated • High Quality – timely, equitable, safe • Person and Family-Centered • Supportive of Clinicians in serving their patients’ needs • Engaged with the community and fulfilling its population’s unique needs

34. Developmental Needs • Cost Recovery • Shared Savings • Pay-For-Performance • Capitation • ACO Involvement • Fire Station Based Clinics • 72 hr. Patient Follow-Ups • Research Evidenced-Based • Quality Assurance

35. To view a copy of this presentation… www.mesaaz.gov/fire www.evwellness.com Find us: mesafiredept East Valley Wellness AZ