Updated: 07/31/2016 10:36 PM
Created: 07/31/2016 9:01 PM
When you think of a paramedic, the image of an ambulance racing to the scene of a crisis comes to mind.
But instead of taking people to the emergency room, community paramedics focus on keeping patients who frequent the ER, out of the ER. Minnesota is leading the country in this creative approach to save health care and taxpayer dollars, while improving lives.
David Johnson is a CP with Hennepin County Medical Center. He meets those in need where they’re at, sometimes under a bridge in Minneapolis, or a home in Minnetonka, even a semi truck in rural Scott County.
On this day, he’s at Harbor Lights in downtown Minneapolis. His first patient is Nicole Clairmont, who has deep blisters on her feet. The sores are a reality of the struggle she faces day in and day out, walking everywhere she needs to go. The 37-year-old is homeless and she’s hurting.
“Torture,” she says, describing the pain.
Everything Clairmont owns fits into a small backpack. She lives and sleeps wherever she lands after dark.
“I’m kind of lost; everyday is so different when I walk onto the streets.”
And somewhere between 20 and 30 times this year, home for a few hours was the emergency room. When we talked with her, she was still wearing the wristband from last night’s visits. Some of her wounds are readily visible, others gradually surface. Her pain is physical and emotional and it’s common. Just ask Carol Rivera of Prior Lake.
“I lost my job, lost my insurance and I can’t afford medicine.”
Rivera is under-insured. Other often under-insured individuals are seniors or people like Doug Jessen.
“I have a Minnesota injury; it happened with a slip and fall on the ice.”
Jessen, of Minnetonka, has been homebound for five months. He can’t walk, much less drive to see a physician.
Dr. Mike Wilcox has treated all sorts of conditions in the emergency room over 40-plus years. He created a program for Hennepin County which targeted high-risk or chronically ill patients, like Jessen and Rivera, who were regulars in the ER. Now, community paramedics, like Johnson, come to them.
“I enjoy dealing with people in times of crisis,” Johnson said.
CPs aren’t just for emergencies. They don’t show up in an ambulance. They drive cars to house calls, set up through clinics.
“It keeps them in their home; a lot of people I’ve seen over the years, if we take them out of their homes, it exacerbates the illness,” according to Kai Hjermstad who teaches the CP program at Hennepin Technical College.
The need to do something different came after hospital staff members realized due to the Affordable Care Act, they would be fined if a person on Medicare had to be treated for the same condition within one month of being discharged.
“If we could deal with patient care needs before they end up in crisis in an emergency room because they haven’t taken their drugs, because they couldn’t afford them,” Dr. Wilcox said.
The kind of dilemmas that have brought first responders to the Harbor Lights homeless shelter a lot. In 2009, there were 428 visits. In 2014, there 1,205, a 300 percent increase over five years. And that ambulance ride along with treatment in the ER can run an average of $20,000 versus a CP visit which costs a fraction of that: $200.
And if a patient isn’t insured, the cost of care is covered by hospitals, funded with taxpayer dollars.
“There’s a ton of gaps and we’re just trying to fill those gaps that people fall into,” according to Amanda Brown, a CP.
Health care organizations like Allina, North Memorial, HCMC and Mayo started sending paramedics to patients on a regular basis.
“We’re here to help people help themselves, not necessarily do anything for them,” Cindy McAlpin, also a CP, said.
Hennepin County reassigned a couple of paramedics to Harbor Lights four days a week, Fridays through Mondays, when most 911 calls would be made. Dominick Bouza runs the shelter.
“They’re part of the village that needs to be here to help our folks through their lives,” Bouza said.
Sometimes the medical care is simply making sure someone takes their medicine or is listening. For 15 minutes, Clairmont received medical attention, a pair of socks and a friend.
“When I saw David I knew he was safe and wouldn’t hurt me,” Clairmont said.
“We can tell a lot about them quickly and help make some decisions about whether we need to go down one route or let’s send them to the hospital,” Johnson said.
In the first year of the program at Harbor Lights, there’s been a 25 percent drop in the number of runs to the ER.
“It’s almost a Godsend,” Bouza said.
To Rivera of Prior Lake, being able to see a CP once a month means everything.
“I would’ve died if it weren’t for them.”
There are skeptics, folks who worry CPs will eliminate home health care jobs, or insurance companies that don’t recognize and reimburse the visits.
“It’s not a moneymaker, it’s a money-saver and all that comes on the back end.”
When asked what difference a community paramedic makes in his life, Jessen replied, “It’s literally lifesaving; it helps with mental health as well as physical health.”
Minnesota is the first state to offer a certified program. So far, about 200 CPs have been trained.
The Shakopee Mdewakanton Sioux Community’s mobile unit in Scott County has treated about 10,000 patients. North Memorial has taken care of another 7,000 people, helping to cut ER visits in half.
The state only gets reimbursement from Medicaid. CP programs are funded by grants, which aren’t guaranteed year to year.