Program set to fill gap in healthcare

McCOOK, Neb. -- A relatively new concept which enlists paramedics to make basic healthcare house calls on residents is coming to McCook after receiving support from city leaders earlier this week.

"Community Paramedicine" started gaining traction about five years ago in rural parts of Minnesota and Colorado, according to McCook Fire Chief Marc Harpham. "Areas where folks really can't get out to go see a doctor when they're ill," he said during Monday's regularly scheduled City Council meeting.

Harpham asked councilors to approve a memorandum of understanding between the McCook Clinic, Community Hospital and the City of McCook Fire Department allowing his department to participate in a Community Paramedic Program. The program intends to lessen the burden on emergency personnel in rural areas by providing scheduled healthcare needs to a limited number of rural residents who lack access to primary care and regularly misuse 911 services for routine healthcare. The program will have a maximum of 10 participants at a time and there will be no charge to the patient.

Similar programs are already underway in Scottsbluff and Omaha, as well as in other states, and city officials see it as an opportunity to increase healthcare for residents while decreasing the number of ambulance calls. The hospital and clinic would also realize a savings stemming from a reduction in the number of repeat emergency visits.

Harpham said he was approached by City Manager Nate Schneider and representatives from the clinic and hospital, asking him to look at some things a local program could provide.

"After several meetings the program that we've come up, basically, allows the hospital and clinic to screen patients, to see which patients would fit into this program. These are patients that kinda fall through the cracks, so to speak. They don't qualify for home health," said Harpham. He said participants would be those that are typically seen in the emergency room a lot and transported via ambulance repeatedly.

"The overall goal I think for us is to minimize those transports and in-turn lessen the emergency calls," said Harpham.

The program would be capped at a maximum of 120 patients for year one. It would be no more than 10 patients at a time with each patient visited once per week for four weeks. Harpham said the intent would be to visit patients initially within 24 hours of being dismissed from the hospital or clinic, followed by three visits each a week apart.

The program intends to schedule the patient meetings during a regular work day while recognizing emergency calls would prevent emergency responders from making some of the appointments. The program would not require additional staff or increase overtime for the fire department.

The program would cover residents within the already established coverage area for the McCook Fire Department and Harpham anticipated the majority of participants would be residents living within McCook city limits.

"Those visits would just consist of doing some basic assessment, blood pressure, vital signs, checking sugars, doing some education with them if we need to. All of the things that we intend on doing with this are currently within the regulations, within our scope of practice as paramedics but also as EMTs," said Harpham.

The only anticipated expense would stem from minimal equipment and supplies that would be purchased with a foundation grant. The Community Hospital Health Foundation has committed a $10,000 grant towards the program. $5,000 available right away and another $5,000 available in June, according to Harpham.

The Memorandum of Understanding approved by City Council Monday also makes the program eligible for another $2,500 educational grant.

Harpham said he thought the program could really blossom into something long-term, adding there was currently no state-level regulation but legislators were looking at something that would allow the program to establish a fee schedule to charge insurance companies. If some form of legislation isn't implemented at the state level he said an evaluation of the program and decision on its future would be planned for at the eight month mark.

The program also provides a unique opportunity for communities to localize healthcare to the needs of the community. Harpham said Scottsbluff's program only addresses two specific illnesses with patients. Omaha and McCook's proposed programs both differ and nationally a wide range of options are being implemented.

"Each one is very unique. I think that's the neat thing about this," said Harpham, adding it offered paramedics the opportunity to do something vastly different than the hustle and bustle involved with emergency calls. "Making house calls and spending time with folks on a schedule, so that hopefully we're preventing or minimizing those three o'clock in the morning calls for patients that really don't need to be transported to the hospital by ambulance."

McCook would be the third city in Nebraska to implement such a program, with approximately 10 other Nebraska communities considering similar programs. The program comes with little risk from commitment as well.

Schneider said the Memorandum of Understanding between McCook Clinic, Community Hospital and the city wasn't an actual contract and any member could back out if it wasn't working for them.

Council members voiced support for the program before approving the memorandum on a unanimous vote.

"I think it's a wonderful idea," said Councilman Bruce McDowell. Councilman Gene Weedin echoed support and indicated he was excited to see McCook once again taking a lead position among Nebraska communities.

Harpham said the program also provided another opportunity for veteran emergency responders to stay active in their later years when other aspects of the career became too physically demanding.

Councilman Jerry Calvin agreed and said it was difficult to see individuals with extensive training and experience "walk out that door," adding the program would be a career extender.