Lastly, when comparing the cost of care between EDs and clinics, the comparison must be apples to apples. ED costs generally are bundled per visit (facility, doctor, lab, radiology), but clinic costs usually do not include ancillary testing or consultations, nor do cost-saving estimates include the cost of the CP service or the second visit for those patients referred from alternative destinations to the ED.
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ACEP Now: Vol 34 – No 06 – June 2015Recognizing the patient risks of CP programs, the ACEP Board of Directors wisely included this final bullet in the October 2014 ACEP CP policy:
“Assurances that if a person calls 911 (or similar emergency number) for a patient’s apparent emergency medical condition or medical emergency and requests an ambulance, the patient has a right to a medical screening examination and stabilizing treatment by a qualified medical person in accordance with EMTALA. For the purposes of an EMTALA-mandated medical screening exam, paramedics and community paramedics are not believed to be qualified medical persons.”3
Dr. Sugarman is chairman of emergency services at Sutter Delta Medical Center in Antioch, California.
References
- Morganti KC, Alpert A, Margolis G, et al. Should payment policy be changed to allow a wider range of EMS transport options? Ann Emerg Med. 2014;63:615-626.
- Office of Statewide Health Planning & Development, Community Paramedicine Pilot Project, HWPP #173, Addendum #1. Revised June 6, 2014. Accessed April 23, 2015.
- ACEP Clinical Policy. Medical direction of mobile integrated healthcare and community paramedicine programs. Accessed April 23, 2015.
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One Response to “Opinion: Paramedicine Diversion Programs Pose Patient–Safety Risks”
June 28, 2015
David Persse, MD FACEPTom,
Great to see you in print! I liked your article, and I agree with much of what you said. I also liked Melissa Costello’s counterpoint, and in fact think you are both correct. “Community Paramedicine” is a poorly defined term in my opinion. Its implementation is as varied as the imagination. As it turns out, here in Houston my system has recently (Dec 2014) launched a hybrid version we call Emergency TeleHealth And Navigation (aka ETHAN) for an emergency physician based EMS diversion program. Google “ETHAN EMS Houston” if you are interested. To date we have triaged over 1300 patients with 80% not being transported by ambulance to hospital. About 40% go by cab to a hospital, but the rest are mostly referred to a project member local clinic or given home health instruction.
Anyway, good to read your thoughts.
An old friend,
Dave