~GOODYEAR FIRE DEPARTMENT~

Community Paramedicine

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Goodyear, Arizona wins All-America City Award - Florida, 2008

One of the reasons Goodyear, Arizona won the All-America City award in 2008 was due to it’s ability to collaborate.

Now, the award-winning city is weighing the odds of a new collaboration which has the potential to solve overcrowded emergency rooms and long ambulance wait times while improving the city’s 911 system.

This effort is deserving of our "People of the West Valley" recognition.

On December 14, 2015, Goodyear lawmakers gave the Goodyear Fire Department the green light to apply for a grant which would kick off an innovative health care model in the West Valley. This nationally innovative program - and much-anticipated team work - is called Community Paramedicine… also known as “CP.”

Community paramedicine (CP) is a new and evolving model of community-based health care in which paramedics function outside their customary emergency response and transport roles in ways that facilitate more appropriate use of emergency care resources and/or enhance access to primary care for medically underserved populations." ~California EMS Authority

Since the inception of Obamacare, or the Affordable Care Act, communities have seen the need to get more creative in caring for its residents. Why? Under the healthcare law, hospitals are getting FINED for serving patients who are readmitted within 30 days of their discharge.

The five types of illnesses hospitals get fined for under the law are:

• Congestive heart failure
• Chronic obstructive pulmonary disease
• Pneumonia
• Joint replacements
• Heart attacks

Goodyear Fire Chief, Paul Luizzi, presented the CP test pilot plan to city lawmakers and explained, "West of I-17, we know 1,261 patients were readmitted within 7 days, not even the 30 days, but 7 days of being discharged. 60% of those patients were discharged without any home healthcare services whatsoever."

Check this out… Since the beginning of 2015, 395 emergency medical service calls were made by just 44 patients. These are patients calling 911 for help. “Frequent users” of the 911 system are those who rely on it three or more times in a month - or 12 or more calls in a year.

How much does the average 911 call cost taxpayers using our current response system? Chief Luizzi says, “Today we know when a 911 call goes out, it costs us about $23 to dispatch that call.” Those calls are dispatched through the Phoenix Fire Department. Goodyear is charged on a “per call” dispatch. “But, we also have to learn, what are the other associated costs with a call?” Under the current 4 person response model: It costs approximately $254 per dispatch call.

There are gaps created by timing of discharges, availability of follow-up, communication failures between in-hospital and out-of-hospital physicians, legal barricades, high demands on outpatient practices, geographic distances, provider shortages, access to care, and, more generally, 24-7 needs in a nine-to-five world,” ~Joseph Harrington as quoted in ACEP Now

As described in ACEP Now, The Official Voice of Emergency Medicine, today’s 21st-century health care system has a “multitude of discontinuities.” The health care system is motivated to develop “care networks” to help patients enjoy healthier and longer lives. The barriers to make that happen are many. “We are seeing rapid consolidation of practices into bigger systems, but we have not effectively identified a way to handle the transition between different settings. There are gaps created by timing of discharges, availability of follow-up, communication failures between in-hospital and out-of-hospital physicians, legal barricades, high demands on outpatient practices, geographic distances, provider shortages, access to care, and, more generally, 24-7 needs in a nine-to-five world,” contemplates Joseph Harrington from June 2015.

So, the Community Paramedicine program is meant to more appropriately provide services for medically under-served people - such as the elderly and chronic condition patients. CP allows paramedics and community partners to help coordinate care for patients who otherwise would use 911 or emergency departments to serve their medical needs.

If this grant is awarded to Goodyear, the Community Paramedicine test pilot program would analyze the cost for 2 person crews and measure the decrease in ER wait times.

Councilmember Joe Pizzillo suggested setting up a separate fund to track costs and revenue. Chief Luizzi says he will come back to council with all of the numbers once the pilot is completed.

Community Paramedicine does NOT replace other providers. It’s a new model. And 100 agencies in 33 states work in a CP environment. Some of these CP programs use a medic, RN (nurse), and pharmacist as a provider team.

These services would fall under the fire department’s EMS system creating a unique collaboration between fire and hospital partners in the West Valley.

In Arizona, six communities are using varying Community Paramedicine models. They are:

• Tempe
• Chandler
• Rio Rico
• Mesa
• Buckeye Fire Department works with Banner Estrella
• Scottsdale

So, what does Goodyear need to do to jump on the CP bandwagon? Chief Luizzi has identified three minimum requirements; Equipment, training, and staffing.

First, Goodyear is building a network of collaborating partners. The city knows it will need to institute a CP program using a two-person approach to EMS calls. These two-person units would be made up of one Goodyear paramedic and a regional partner. “It wouldn’t all be on Goodyear,” and Chief Luizzi says the six-month pilot would help determine the cost-per-call for moving forward.

What about vehicles? Fire trucks will not be used. It’s possible they’d use a pool vehicle or a vehicle, (Chevy Tahoe), from the police department which is up for replacement… by holding it for six months during the test pilot.

Additionally, calls would be split into two units. The “North Unit” would be Surprise, Sun City, and Peoria. The “South Unit” would be Goodyear and Avondale.

“In the 20 hours a week we would be in service in the South Unit, we’d go out and visit those patients in those five days. We really wouldn’t be extending much beyond the Goodyear/Avondale borders. And then Peoria would handle the Peoria, Sun City, and Surprise calls.”

Litchfield Park is included in the Goodyear/Avondale zip code area.

Mayor Georgia Lord expressed concerns about competing hospitals. Stan Holm of Abrazo Health responds, “This is a collaborative effort, that even outside our walls and competition, we come to common ground.”

I can confidently tell you that you shouldn’t have to look to any taxpayers having to fund this going forward from the pilot.” ~Stan Holm, Abrazo Health CEO

It’s not expected taxpayers to pick up the expense for this program. In fact, several funding possibilities exist, including:

• Insurance carriers
  
• Hospitals
• Primary care physicians using case managers
• Grants
  
• Medicaid
  

Stan Holm, Abrazo Health CEO, says, “I can commit to you tonight that you should feel confident that funding sources inclusive of Abrazo West… grant funding, additional pilots, what the federal government is looking to do, access to Medicaid being a reimbursement as discussed, there are so many significant funding sources wanting this to be successful to keep patients healthy from coming back to the hospital, I can confidently tell you that you shouldn’t have to look to any taxpayers having to fund this going forward from the pilot.”

Currently, Goodyear is working with the non profit, St. Luke’s Health Initiative. The organization has a grant worth $125,000 for innovative programs. “We would like to first look at potential grant funding through St. Luke’s Health Initiative which will cover the salary costs for personnel assigned to this 6 month pilot project,” explains Fire Chief Paul Luizzi, City of Goodyear. The grant application is due January 22, 2016.

Stan Holm, Abrazo Health CEO and Goodyear Fire Chief Paul Luizzi - December 14, 2015

You don’t know what to do. You can’t get hold of your doctor because they don’t like taking phone calls anymore. And… you don’t know what to do. ‘Who do I call?’ I was just in this situation a month ago with some serious health issues and I was like, ‘Now what do I do?’” ~Councilmember Sharolyn Hohman

Vice Mayor Sheri Lauritano had some great questions about how patients opt into the program. Chief Luizzi says case managers will ask patients discharging from hospitals if they’d like to opt-in and the program will require a level of trust for opting to go with a new provider.

Mesa, Arizona’s Fire and Medical Department received a Health Care Innovation Award funding grant to test a new mobile integrated healthcare model. “In 2014 we were able to exceed goals of insurance monetary savings, as we diverted 54% of ambulance transports to the emergency department among our 9-1-1 low-acuity patients who were evaluated by Community Care Units,” states Gary Smith, MD, MMM, FAAFP - as reported by EMS World.

Councilmember Sharolyn Hohman - December 14, 2015

Councilmember Sharolyn Hohman has a unique perspective on the Community Paramedicine test pilot as she says she is someone who has needed to use the 911 system. She says, “Part of the challenge for…. I’m going to speak for the patient side… It happens to you. You don’t know what to do. You can’t get hold of your doctor because they don’t like taking phone calls anymore. And… you don’t know what to do. ‘Who do I call?’ I was just in this situation a month ago with some serious health issues and I was like, ‘Now what do I do?’” Hohman’s children were able to help her. She says she’s excited about this program as it provides a solution for people who need it.

Councilmember Bill Stipp addresses Goodyear residents and notes, “We are going to embark on the next frontier of EMS. So, as a community. We are going to say ‘yes’ to that or ‘no.’ We are here today because we have a grant application due January 22nd. The grant monies and program won’t start until July 1.”

Stipp asks Chief Luizzi if - during that wait time of five months - he can create very specific measurements to assess. “We are starting a new service. If it’s successful, we are going to want to continue it.” Stipp wants to know what success looks like.

Councilmember Bill Stipp - December 14, 2015

We haven’t heard any of the risk. We have a litigious society… It’s unbelievable what people sue for." ~Goodyear Mayor Georgia Lord.

What happens at the end of the test pilot? Goodyear is looking at creating a sustainable payment model and want to ensure other healthcare partners are willing to assist in the long-term.

Government regulations from the state and federal agencies play a factor, as well. Make no mistake, the city knows those regulations are down the road. And of course, what will happen in the workforce? Is it a way for some to stay in the force longer? Paramedicine is less stressful on the body and could be a way for aging employees to stay rather than retire.

Vice Mayor Sheri Lauritano and Goodyear Mayor Georgia Lord - December 14, 2015

Goodyear Mayor Georgia Lord makes the most eye-opening observation of the night. “We haven’t heard any of the risk. We have a litigious society… It’s unbelievable what people sue for.”

Chief Luizzi is relying on the guidance of an experienced doctor who, he says, will not allow Goodyear Fire to creep outside of its protocols. If someone really does need 911, the paramedics will activate that system rather than take on the call themselves.

Now, Goodyear will move forward with applying for the grant. If awarded, Chief Luizzi will publish results of the pilot program and report back to council once completed.

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We love that the City of Goodyear continues to step up to the plate with innovative, collaborative ideas which benefit the West Valley as a whole.
Thank you!