Who pays for community paramedic training programs?

Not-for-profit, 501C3 EMS agencies have a great opportunity to step ahead of the curve and into the future of EMS by developing community paramedic or more succinctly titled “integrated mobile healthcare” training programs for EMS personnel.

CMS, the agency that pays for all Medicare claims in the US, has already funded a $9 million  grant in Reno, Nev. to study the overall healthcare savings impact of such a program via a community paramedic program’s implementation by REMSA and the University of Nevada Reno. 

To date, other successful programs have been self-funded and/or funded in part through reimbursements by hospitals and/or physician specialty groups, i.e. MEDSTAR in Fort Worth, TX and the Eagle County Colorado EMS agency near Vail, CO. Even FEMA may be interested in potentially supporting such programs since the Affordable Health Care Act recommends that fire departments and EMS agencies have community paramedics on staff.

Those agencies responding as 911 ambulance providers  interact daily with high risk/high cost healthcare system patients. They also witness the inappropriate use of the emergency 911 system/hospital emergency departments (EDs) and the resultant unnecessary waste of resources that could be re-directed to benefit the chronically ill and the medically underserved, and used to educate citizens with particularly risky health behaviors. 

To these ends, there may be dollars available in the future earmarked for funding training programs that align with the recommendations of the International Roundtable for Community Paramedicine, the Institute for Health Improvement and CMS. CMS’ call to action is to offer better care, better access to care at lower costs.

These new community paramedics, under intensified medical direction and using enhanced medical treatment protocols, need to be educated and skilled at integrating specially selected patients’ medical house calls with other care providers’ efforts thereby creating a “medical home” (a central repository for electronically integrating patients’ medical records) for those who currently have none. 

These community paramedics might perform patients’ environmental assessments, conduct mobile diagnostics, install and instruct patients’ bio-medical devices, offer medication reconciliation/instructions, and provide protocol-driven medical treatments at patients’ homes. 

Additionally, the program might be designed to impact a number of unsafe or risky health care behaviors prevalent in the service area through face-to-face patient education and illness and injury prevention outreach (i.e. direct patient education, community presentations, Internet, broadcast media, etc.).

Many states have already begun exploring community paramedic curriculums for specially selected EMS professionals.  Almost all of these curriculums include all or in part the topics listed below.  Of course these courses augment the states established certifications and skills attributed to paramedics and in some cases, critical care paramedics.

• Social Determinants
• Role of the community paramedic in public health (Primary care)
• Cultural (Spiritual and health literacy)
• Community paramedic’s role in communications
• Personal safety/self-care/professional clinical services (Self-care is about community paramedic stress and professional boundaries)
• Oral assessments/referrals
• Mental health assessments/referrals