NFPA Journal - January/February 2020 - 66

EMS
Revolution

THE

challenges they've faced or
could see happening as MIH
expands further.

LESSONS LEARNED

TIPS FROM EXPERTS ON WHAT WORKS-AND WHAT DOESN'T-
WHEN CREATING A MOBILE INTEGRATED HEALTH PROGRAM
There's a well-known saying in EMS circles that if you've seen one EMS service,
you've only seen one EMS service.
"Even more to that point, if you've seen
one mobile health care medicine program, you've seen only one because the
neighboring district may have something
completely different," said Jeff Siegler, a
doctor and the medical director of three
EMS systems in the St. Louis area.
The fact that MIH has a different flavor
everywhere is more of a feature than
a flaw, according to experts-if you're
taking a cookie-cutter approach to MIH,
they say, you're probably doing it wrong.
"Every community is different," said
Matt Zavadsky, president of the National
Association of EMTs and an executive at
MedStar Mobile Healthcare in Fort Worth,
Texas. "What is driving high hospital
readmissions in your community-is it
heart failure? Diabetes? Mental health?
What is driving high ER visits? What are
the resources available? The answers to
those questions are going to be different
in every community. That's why you have
to do a gap analysis."
The gap analysis process, used to
figure out where EMS systems can get
the most bang for their efforts, is central to the recommendations in the new
NFPA 451, Guide for Community Health
Care Programs, which Zavadsky and
Siegler both contributed to as technical

66 | NFPA JOURNAL * J A N U A R Y / F E B R U A R Y 2 0 2 0

committee members. The goal of the
document, they say, is to provide a roadmap for EMS leaders to quickly get up to
speed and create MIH programs that are
sound from the outset and built to last.
While MIH has brought tremendous
value to many communities and EMS
systems, the complexity of the health
care system and the sheer number of
stakeholders means there are pitfalls
that are easy to fall into. EMS agencies
that fail to answer crucial questions, or
don't include key health care partners in
decisions, can end up expending a lot
of effort for little return.
The value of NFPA 451, Zavadsky said,
is what he affectionately refers to as
"scar avoidance."
"I can show you the scars that
(MedStar) has from things that didn't
work out real well," he said. "That's
why the NFPA 451 project is so beneficial-you've got a resource now that
any agency or practitioner can go to.
If you've been asked to do a mobile
integrated health care program, which
most agencies will, here's how you do
that. Here's the guide."
Since both Zavadsky and Siegler have
been involved in building and operating
MIH programs, NFPA Journal asked them
to list a handful of key lessons they've
learned over the years, along with mistakes they've made and unexpected

COLLABORATE WITH STAKEHOLDERS
Z: Don't duplicate things that are already
available in the community; instead, you
need to find the gaps that you can fill.
We built our program in collaboration,
not in competition, with the rest of the
health care system. We did a gap analysis with our stakeholders-the hospitals,
the payers, the United Way, and others.
We held forums and asked them, "What
are the gaps in the health care system
where our patients, your patients, are
falling through the cracks, and what role
could we have as an EMS organization
to help fill those gaps?" We built our
programs based on our community partners' responses to those questions.
Working collaboratively with your local
community will ensure your program is
not only successful, but also economically sustainable. If people view it as
valuable, they're usually willing to fund it.
GET THE ECONOMICS AND PRICE
STRUCTURE RIGHT
Z: When we first started doing integrated
health care programs, we did activitybased costing. For example, if we found
that it was going to cost us $65 per visit to
have a community paramedic go to somebody's house, when the client would ask
us how much our services cost we would
tell them $70. But what we learned is that
the value we bring is way more than $70.
The value to the payer is the avoidance of
two $2,500 ambulance ride payments for
a round-trip visit to the ER.

GETT Y IMAGES

GLOBAL TREND A community paramedic on a call in
Toronto. The MIH/community paramedicine model is
expanding rapidly in several countries, including Canada.

BUILD WITH PURPOSE
Zavadsky: Before you start
a specific MIH program, you
always have to ask yourself
the questions: "Am I going
to make a difference?" and
"Is this something that we
can bend the curve on?" You
need to be really honest and
really objective.
For instance, if someone asks you to do an MIH
program that addresses
the excessive emergency
department use for patients
who are on renal dialysis, look
at the trips to the emergency
room that that population
has had. If most trips result
in the patient being admitted
to the hospital because they
were in acute renal failure,
you're going to have a hard
time bending that curve. Just because
you can do something doesn't mean you
should.
NFPA Journal - January/February 2020

Table of Contents for the Digital Edition of NFPA Journal - January/February 2020
