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Some Paramedics Doing Less Transport, More Treatment At Scene

Posted: June 18, 2014

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Cities and towns call it community paramedicine, and say the goal is to lower hospital costs by training emergency crews to do more treatment at the scene. But who actually pays for these house calls?

Speeding to a house call? Training paramedics to do more treatment at the scene can be pricey, critics say.

Speeding to a house call? Training paramedics to do more treatment at the scene can be pricey, critics say.

It's being called the house call of the future: Ambulance crews rush when you call 911, but instead of taking you to the emergency room, they treat you at home.

Community paramedicine, as it's called, has recently drawn a resurgence of interest from towns and states nationwide. Its aim is to bring down the costs of hospital treatment, but some who have tried the approach worry about who ends up paying for the service.

David Kimbrell, the fire chief in Hall County, Ga., and Scot Phelps, a former paramedic and a professor of disaster science, joined host Robin Young from NPR's Here and Now Tuesday to discuss the pros and cons of the approach.


Interview Highlights

David Kimbrell on the advantages of community paramedicine

They're able to do blood withdrawals and do some analytical tests on the scene. They have a centrifuge. They can spin down blood to do various blood tests. ... None of those things are [typically] done by paramedics on the scene. So if you think about health care, we're basically going back to the old house calls by the doctor.

David Kimbrell on funding the new service

We were seeing more and more people calling 911 and our medics were treating them on the scene, and then we were not getting reimbursed for that — because a paramedic has to transport in order to be reimbursed by insurance and Medicare and Medicaid. So we were able to utilize a nurse practitioner. The nurse practitioner and the paramedic [work together] as the mobile care team. Then, if they go out and treat a patient, it is reimbursable through the nurse practitioner's license.

Scot Phelps on a previous attempt in New Mexico

We tried this in 1995 in Red River, N.M., and what we found, after spending hundreds of thousands of dollars, was that it didn't actually save any money or improve any care. So [that community] abandoned it, and now, eight years later, it's the topic du jour.

Scot Phelps on the response of paramedics to the service

I don't think paramedics are really anxious about being replaced, because all the data shows that all the ambulance calls across the country — and, in fact, across the world — are increasing at about 5 percent a year. The problem is that very few communities have sufficient numbers of paramedics. There is [an] extraordinarily high turnover. That was one of the key conclusions of the 1995 Red River project — that with the high turnover, the training costs add up kind of quickly.

Copyright 2014 WBUR-FM. To see more, visit http://www.wbur.org.

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