Can ambulance services help keep patients at home?

Ambulances benefit from frequent users. Place a call for patient transport and a bill is generated.

But what if the ambulance service was paid to keep patients out of the hospital? What if the model was rebuilt, so that the ambulance service brought the health care to the patients before they needed hospital care?

Officials at MedStar Mobile Healthcare of Fort Worth, Texas, asked those questions about five years ago. The ambulance service began to analyze which part of the health-care system stood to lose money if a patient used their services, said Matt Zavadsky, public affairs director. Many of these patients would have no insurance or low-paying coverage like Medicaid.

"Our whole philosophy is to find who is at risk for the cost of the care — the hospice, home health care, physician group, Medicaid — because the ones at risk for cost are motivated to get [patients] into lower cost, high-quality programs," he said.

Often, that entity at risk for losing money was MedStar, which has a 27 percent collection rate because of low Medicare and Medicaid reimbursements and unpaid patient bills, Zavadsky said.

Because some of the patients it saw were the same ones virtually every day, MedStar specialists knew there was tremendous waste in bringing most of them to hospitals. "The vast majority of patients who call for 911 don't need to be there," Zavadsky said.

MedStar rolled out initiatives to bring in-home care to patients they were constantly transporting into area hospital emergency rooms. It also developed programs to identify patients at high risk for costly readmissions into hospitals.

"We used to be an ambulance service," said Zavadsky. "Now we're a mobile health-care provider."

Meanwhile, MedStar worked out plans with health-care providers to determine how much they spent on caring for difficult types of patients. Knowing that hospitals were losing money on those patients — and that the federal health-care law would be reducing payments to hospitals further for too many readmissions — MedStar set up contracts to receive part of what the health-care institutions saved by preventing the readmission.

The results have been impressive. An analysis of the 2,200 patients that have graduated from MedStar's mobile heath-care programs found that they have saved nearly $3.6 million in health-care expenditures, the company says.

Its program for frequent emergency department patients, called the EMS Loyalty Program, reduced 911 transports by 29 percent during a typical 30-to-90 day enrollment period and by 82 percent in the 12 months after a patient completed the program, the analysis found.

The results were so noteworthy that other emergency medical services began asking themselves the same questions MedStar executives did in 2009. Several months ago, Zavadsky spoke to the Eastern Pennsylvania EMS Council about his company's transformation.

It got members moving. John Kloss, the council's executive director, said a review of who was using ambulance service was "astounding."

At Cetronia Ambulance in South Whitehall Township, one patient in a 12-month period called for paramedic transportation 113 times, CEO Larry Wiersch said. Cetronia this summer was among the area emergency transport services that started analyzing who was calling them and the reasons for the calls.

Time and time again, the patients calling for ambulance service had fallen in their homes or in nursing homes, he said at a recent EMS council meeting. Many of those events, he said, likely were avoidable.

As the EMS providers told their stories and heard about the first results of their data analysis, it was almost like the light bulbs that went off over the MedStar executives' heads five years ago began to flicker locally.

The more ambulances tied up transporting people who had preventable accidents, the fewer ambulances would be available to true emergencies, Wiersch realized. "It shouldn't necessarily be our issue, but it is our issue," he said.

Added Kloss: "Maybe we just touched on something huge that we never thought of before."

Photo via The Morning Call/Redflash Group contributed photo.

This story was originally published in The Morning Call.