Money. That’s why.
There simply isn’t a financial incentive for a private EMS service to run a community paramedic program.
Hospital-based EMS services have a financial incentive to run a community paramedic program. If the hospital-based service can reduce ER visits, and therefore reduce hospital admissions, then there is a financial incentive for them to run a community paramedic program.
Fewer chronic visitors in the hospital = more ER beds = more available inpatient beds = more insurance payments for the hospital.
Plus, with new healthcare regulations stipulating that hospitals won’t be payed for re-admissions within 30 days for the same problem, hospitals really have an incentive to reduce visits by chronic users. Visit the patient in the home, keep them at home, and they won’t come to the hospital as often.
County-based EMS services likewise have a financial incentive to run a community paramedic program. Specifically, the county third services, not fire-based services, but I will get to them.
County-based EMS services have more leeway to deny or refuse transport to patients who meet certain criteria, or at least they do where I have worked. Having trouble urinating? We aren’t gonna take you to the hospital. Can’t sleep? Take a melatonin. We aren’t taking you to the hospital. But those chronic users learn how to work the system. Having trouble urinating turns into abdominal pain with difficulty breathing. Now we have to transport. Can’t sleep turns into headaches and dizziness, or general weakness, and now we have to transport.
These patients either aren’t insured, or won’t pay their bills. If, on the off chance they are insured, reimbursement from their insurer are low, and the copay won’t be covered. Transporting these patients becomes a net loss for the county service. Keep them at home, and more units are available to transport the patients for whom reimbursement rates are higher, or who actually need an ambulance to take them to a hospital.
It seems like ‘want’ and ‘need’ have become synonymous lately.
Fire-based services also have a financial incentive to implement a community paramedic program. If the fire-based service can send a community paramedic to a chronic EMS user’s house, and keep that user from activating 911 or requesting EMS, then those EMS units are available to run more calls that actually require EMS, and it keeps other fire units in service and available for fire calls. Or the EMS calls that fire services shouldn’t be running anyways.
But the private service that operates on a ‘you call, we haul’ basis has no incentive like the other three models. There is only an incentive for the private service to transport.
Transport – get paid. Don’t transport – don’t get paid. Pretty simple.
I have worked at various private EMS services for the past 10 years, and not once have I told a person that I was not going to transport them to the hospital. Every single time someone wants to go, we put them on the cot and take them to the hospital of their choice.
If the chronic EMS user does not have insurance, or doesn’t pay for their use of EMS, then the difference becomes a tax write-off, or is covered by a government subsidy of some sort. Private services aren’t concerned with readmission penalties at hospitals, and they aren’t concerned with overburdening an already busy ER.
More paramedics in ambulances = more paramedics to transport patients. Why would a private EMS owner or manager intentionally take a paramedic off of an ambulance, and put that paramedic into a vehicle to visit patients at their homes? That goes contrary to the very mission of the private service, which is to transport anyone and everyone who wants it.
More paramedics on ambulances = more paramedics to transport patients.
I wish it weren’t this way, and I wish that community paramedic programs could flourish in a private EMS service, but I don’t see it happening.
Maybe I’m cynical, but maybe not. I would be interested to see the private EMS service that has implemented community paramedic program with success.