Fremont County EMS introduces new service to reduce emergency calls

(Lander, Wyo.) – Fremont County Emergency Medical Services launched an in-house pilot Mobile Integrated Health Program in the Dubois area this week, according to Jess Miller, RN, Fremont County EMS Mobile Integrated Health Clinical Supervisor. The proactive idea is to reduce repeat visits to hospitals by chronic patients and treat them before they become an emergency case requiring an ambulance and re-admission to a hospital.

“We have six patients with chronic illnesses enrolled in the program to start. We want to keep it small initially so we can quantify the data and become comfortable with the program,” Miller said. Of 200 such programs nationally, Fremont County’s is the first in Wyoming.

“We will eventually expand this service county wide, but we want to run the pilot in Dubois first,” he said. He also said one of the EMS Command vehicles (pictured above) would be used on visits instead of an ambulance. “It’s less intrusive,” he said.

To learn more about this new Fremont County EMS program, read the information copied below: 

Mobile Integrated Health is an extension of care plans instituted by Physicians for chronically ill patients. The MIH Program will provide home visits to an identified group of patients who are identified by their primary care-givers (Physician, Nurse Practioner) that are most likely to utilize Emergency Department visits or admissions to the hospital for the same diagnosis.

MIH was instituted in the late 1990s and early 2000s in the super rural areas of Nova Scotia, to provide diagnostics and treatment to patients who had poor access to standard health care venues. The result of long travel times to approved clinics or hospitals often led to poor quality of life and more frequent and longer hospital admissions for the patients. The cost to the system and patient skyrocketed because the disease process exacerbated in these rural areas, meaning patients got sicker and didn’t have reasonable access to care, so by the time they were seen, their conditions were much worse than they could have been if visited regularly by health care professionals.

These patients often fell in the “gaps” left by regulations that did not qualify them for approved home health visits by nurses and travel times that were sometimes insurmountable.   Emergency Medical Service providers, with complete infrastructure of mobile treatment options, are filling the need in many communities. “It is a different role than traditional emergency medicine dynamics”, Miller said. “But it fills a need, especially in a large rural county like ours, where access to care is a major problem.”

Miller said “the main tenets of MIH are 1) Access to care, 2) Improved patient outcomes and 3) Reduced costs to the patients and the system. The primary categories we will integrate are diabetics, COPD, congestive heart failure patients and chronic conditions that require consistent monitoring

Miller and EMS Director Joseph Zillmer developed the program early in the year after detailed analysis of the changing health care environment indicated that preventative medicine would become a primary area of focus and reimbursement from national payers (Medicare, Medicaid) would become reduced for repeated treatments and admissions for chronically ill patients.

Zillmer and Miller recently attended the International Mobile Integrated Health Conference in Reno, Nevada. The conference had representatives from nine countries, many have established MIH Programs that have operated for over five years. The prevailing data proved that the MIH Program accomplished two main things consistently; a higher quality of life for patients that reduced continued hospital admissions and the overall cost saving to the system.

Zillmer shared some of the data, “A congestive heart patient that is re-admitted to the hospital within 30 days of the last admission, will cost $17,000 for a short stabilization period, and with new reimbursement requirements, the hospital will not receive normal payment. The cost is bad for the system, and the toll on the patient and family is horrible”.

Zillmer also stressed that these patients are non-qualifiers for normal home health visits, so home nursing is not a financial option. “The concept of the program is to treat patients more effectively, and keep them out of the hospital whenever possible”. The result is a win-win. Patients are healthier, they stay out of the hospital for longer sustained periods of time, and the cost savings are potentially substantial.

The Fremont County EMS Mobile Integrated Health Program is currently not funded, but several specific grants are in the works and Zillmer expects that the new ICD 10 Codes (Medicare qualifying reimbursements) will start probably next year. The FCEMS program has four phases, including a rolling Diagnostic Vehicle that will provide several testing formats, including blood tests, prescription audits with refills, advanced cardiac monitoring (12 Lead EKG) and telemedicine.

“The impact on morbidity, mortality and system cost will be significant, and Fremont County citizens will be on the cutting edge of better health care” added Miller.

–Provided by Fremont County Emergency Medical Services