NHRMC EMS- Community Paramedicine Sarah Rivenbark, EMTP, CP

1. Leading Our Community to Outstanding Health NHRMC EMS- Community Paramedicine Sarah Rivenbark, EMTP, CP

2. Think About • How are patients utilizing their local hospital? • ED utilization • Admission / Readmissions • Average length of stay • Communities access to primary care and specialty care? • Clinics • Home Health • Patient population payor source? • Medicare, Medicaid, Commercial, Self-Pay, VA, Charity Care • Bad debt • Low reimbursement • Penalties

3. Community Paramedicine • Clinically integrated with EMS agencies • Serves to meet the needs of the community by effectively utilizing available resources • Expands the role of paramedics to provide preventative patient care • Delivers care at the right time, right place, at low cost • Fills healthcare gaps without duplicating services

4. Mobile Integrated Healthcare • Component of an existing healthcare system • Ambulatory (out of hospital environment) • Multidisciplinary • Collaborative • Community Paramedicine may be a service line offered

5. Community Paramedic Programs in NC

6. NC Hospital Affiliated CP/MIH Programs • Atrium Health- Transition Clinic and Readmission Reduction • Mission Health - ACO Care Management • Cape Fear Valley - ACO Care Management & Readmission Reduction • UNC Wayne - CHF Readmission Reduction • Lenoir County - COMPASS Program

7. NHRMC Community Paramedic Program Program Highlights: • 5 Community Paramedics • High Risk & MSSP Readmission Reduction • EMS and Emergency Department Utilization Reduction • Provider Referrals • Opioid Reversal Follow-Up • Transition Clinic • Virtual Visits • Orthopedic Pre-Op Visits

8. Collaboration • Pharm D • Community Pharmacist • Home visits with Community Paramedics • Assist with medication errors • Medication Assistance (affordability) • Transition RN Case Managers • High Risk Discharge Phone Calls • Referrals to Community Paramedics • Assist with Case Management / Social Work

9. Community Paramedic Education • Total: 308 hours of didactic and clinical training • 64 hours of classroom • 48 hours of online modules • 196+ hours of clinical training • Hospice Rotation • Cardiology Rotation • Cardiovascular Rotation • Behavioral Health Rotation • Internal Medicine / PCP Rotation • Pharmacy Rotation • Nutrition Education • Community Clinic Rotation • Case Management / Social Work Rotation

10. Community Paramedic Home Visit • Review • Medical History • Medications • Discharge Instructions • Identify Barriers to Care • Correct or Refer • Physical Assessment • Home Safety Inspection • Patient Education • Labs-Point of Care Testing • PRN Interventions • IV Medications ( Lasix, Steroids, Fluid administration, etc.) • Nebulized Medications • Blood Draws • Cardiac Monitoring/ 12 Lead EKG Analysis

11. NHRMC Community Paramedicine • Patients are typically followed for the first 30 days post discharge for readmission reduction. Sometimes longer if patient requires continued support. • Patients seen for care management or utilization reduction are typically followed 30 - 90 days. • One time/ PRN visits, typically referred by a provider, for specific clinical interventions to avoid the emergency department or admission. (IV Lasix push, labs, EKG, etc.) • “Cold Call” visits (referred by health professional) or post prehospital administration of naloxone without transport to the emergency department.

12. The Virtual Visit • Improves patient access to healthcare • Primary Care • Specialty Care • Decrease ED Utilization • Reduces patient exposure • Patient Provider can see patients living conditions

13. Case Study • 75 year-old Male • past medical history of diabetes, renal failure, congestive heart failure, myocardial infarction, and poor medication adherence. • Arrived to PCP office with Foley catheter disconnected and leaking fluid down leg. PCP referred to Community Paramedic Program after previous resources refused to readmit patient. • Seven emergency department visits with three hospital admissions over a 12 month period • Patient admitted into Community Paramedic Program: • Frequent visits to ensure Foley and medication compliance. • Discovered memory loss with possible dementia. • Substance abuse being encouraged by younger neighbors. • Attended physician appointments with patient, worked with family, and Adult Protective Services to obtain mental health evaluation and placement into assisted living.

14. Case Study No Emergency Department Visits or Admissions During CP Involvement

15. CP Leading Indicator Dashboard FY18 • FY18 January thru September Patient Visits - 3,262 • FY18 Readmit Rate for CP Program High Risk Participants is 9.7% lower than NHRMC Readmit Rate. • Average Number of Days from Discharge to Initial Visit – 3 Days

16. CP Leading Indicator Dashboard FY19TD

17. Questions? Sarah Rivenbark, Community Paramedic 910-667-8380 sarah.rivenbark@nhrmc.org