PSOW 2016 - Community Paramedicine in Wisconsin

1. COMMUNITY
PARAMEDICINE IN
WISCONSIN
WHERE ARE WE AND WHERE
ARE WE GOING?

2. Community Paramedic:
Accountable Care Partners
●Viable option for improving the experience of care,
improving the health of populations and reducing
per capita costs of health care
● Bridge existing health care gaps, avoid duplication
● Reduce the cost of overall health care expenditures
● Reduce stress on vulnerable patients and improve
care coordination
● Reduce hospital readmissions and emergency
department utilization and avoid penalties

3. THE VALUE of CP in ACCOUNTABLE CARE
Linking Primary Care & EMS
Enabling
Legislation,
Credentialing
Reimbursable CP
Practitioner
Services Identified
Partnership
Between Hospital
and EMS or FD
ED Utilization
Complex Patients
Without Services
Patient Primary
Care Plan, PCP
Driven

4. COMMUNITY PARAMEDIC WORKFLOW

5. WHAT DOES SUCCESS LOOK LIKE?

6. NEW HANOVER REGIONAL – NORTH CAROLINA

7. ABBEYVILLE SOUTH CAROLINA
COMMUNITY PARAMEDIC EVALUATION REPORT
NOVEMBER 2015
ED UTILIZATION
CP PATIENTS – 58.7% DECREASE VS. CONTROL – 4% INCREASE
INPATIENT UTILIZATION
CP PATIENTS – 60% DECREASE VS. CONTROL – 500% INCREASE
ED CHARGES
CP PATIENTS – $879 DECREASE VS. CONTROL – $126 DECREASE
INPATIENT CHARGES
CP PATIENTS – $1,249 DECREASE VS. CONTROL – $19,960 INCREASE

8. LEGISLATION IN WISCONSIN
STAKEHOLDERS
• PROFESSIONAL AMBULANCE ASSOCIATION OF WI - PAAW
• PROFESSIONAL FIRE FIGHTERS OF WISCONSIN – PFFW
• WISCONSIN EMS ASSOCIATION - WEMSA
• WISCONSIN STATE FIRE CHIEFS ASSOCIATION – WSFCA

9. LEGISLATIVE PROCESS
• Process started by PFFW and Rep. Katrina Shankland (D) Stevens Point
• Bill drafted in late summer 2015
• Outreach to other medical groups:
• WI Nurses Association
• Medical Society of Wisconsin
• Office of Rural Health
• DHS

10. LEGISLATIVE PROCESS
• Stakeholder phone conferences started by PAAW and archived at
www.paaw.us
• List serv started by Rural Health and archived at www.paaw.us
• Stakeholder meeting in Stevens Point – summer 2015
• Support offered by Rep. Amy Loudenbeck (R) Clinton
• Legislation session ended with bill in draft form

11. LEGISLATIVE PROCESS
• All inclusive Stakeholder group reconvened May 2016
• New draft circulated July 2016
• General consensus across the board on issues

12. HIGHLIGHTS OF BILL DRAFT
• Expands definition of EMT to add CP function to current definition
• Actions and training to be authorized by DHS
• Agreement with a hospital or physician
• CP endorsement by DHS
• CP must be part of ambulance provider or hospital
• No Medicaid reimbursement in the bill

13. NEXT STEPS
• Introduce vetted bill when legislative session opens
• Build consensus across other disciplines
• Reach out to local legislators to garner support
• Establish discussions with local hospitals to forge partnerships for
pilots and/or services
• Work to increase training opportunities for certification

14. WISCONSIN PIONEERS
• Green Bay Fire Department
• Greenfield Fire Department
• Madison Fire Department
• Milwaukee Fire Department
• Ryan Brothers Ambulance
• West Allis Fire Department

15. MILWAUKEE FIRE DEPARTMENT
COMMUNITY PARAMEDIC
PROGRAM
Captain Michael Wright NREMT-P CPMIH TEMS

16. PILOT PROGRAM RESULTS OCTOBER
PATIENT 6 MTH PRE 6 MTH POST % CHANGE
Hours of engagement
DA 33.5 15 25 66.67
RB 17 2 4 100
CS 15.5 8 3 -62.5
MK 15 1 1 0
TB 15 3 0 -100
BL 12.5 2 0 -100
SR 38.5 10 1 -90
CH 17 9 1 -88.89
NS 17 4 2 -50
TOTALS 181 54 37
66.67
100
-62.5
0
-100 -100
-90 -88.89
-50
-150
-100
-50
0
50
100
150
1
October 2015 Pilot Data
DA RB CS MK TB BL SR CH NS

17. PILOT PROGRAM RESULTS
NOVEMBER
PATIENT 6 MTH PRE 6 MTH POST% CHANGE
Hours of engagement
RG 14 9 0 -100
CS* 7.5 4 2 -50
DP 27 29 51 75
TW* 16 12 1 -92
JS 13 2 0 -100
GW 7.5 10 16 60
JA 16.5 4 1 -75
MB* 5 3 3 0
MM 13.5 14 9 -36
TOTALS 120 87 83
-100
-50
75
-92 -100
60
-75
0
-36
-150
-100
-50
0
50
100
1
November 2015 pilot data
RG CS DP TW JS GL JA MB MM

18. PILOT PROGRAM RESULTS DECEMBER
PATIENT 6 MTH PRE 6 MTH POST % CHANGE
Hours of engagement
RL 21 38 14 -63.15
JN 14.5 4 0 -100
HH 16.5 1 1 0
LL 22 14 0 -100
PG* 23 13 4 -69
DM* 15.5 21 15 -28.57
JJ* 4.5 21 7 -66.66
GT* 4.5 5 3 -40
MT* 4.5 6 0 -100
DT 21 6 7 14.28
TOTALS 126 123 51
*did not complete program
-63.15
-100
0
-100
-69
-28.57
-66.66
-40
-100
14.28
-150
-100
-50
0
50
1
December Pilot data
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