The $64,000 question – who will pay for community paramedicine? Outlined below are three ways CP is generating revenue. There are no easy answers and we are still evolving, but think about how one of these might be best adapted to your service – or – use these ideas to get your juices flowing and help you come up with an even better approach!

I won’t discuss how to fund the start-up of CP; there are wise minds addressing that topic.  I’m a billing and reimbursement specialist; from the first I heard about CP, I worried about how the industry would get paid for these services – would providers receive reimbursement, would they contract with insurers or facilities, or would they bill patients directly? As it turns out, the answer is “yes” to all! It’s just that the “how” of that financial exchange differs dramatically in large and small EMS systems. We’ll look first at the large services and then go to options for smaller services.

Thanks to the outreach efforts of the MedStar team, many of us have heard about their successful endeavors to lower 9-1-1 use and reduce hospital admissions without jeopardizing patient care. For larger services, revenue may come from relationships with facility payers and insurers with whom they contract. Hospitals are on the hot-seat in regards to their own compliance, especially over medically necessary admissions and readmissions. EMS providers who arrange to visit a patient in the home post-discharge and help with medication, food, social services and follow-up care have been able to reduce readmissions significantly and drive down 9-1-1 calls.  Another aspect of their service is to handle lower acuity 9-1-1 calls differently by directing patients to needed services that do not involve an ER visit.

For these scenarios, it may be in everyone’s interest to have a contractual relationship with the hospitals, or even with the payers who provide coverage to those patients. Hospitals and/or the insurers save money from hospital admissions that are no longer needed or ambulance transports that are saved.

But that model may not work for you. As noted by NAEMT, “…CP is an organized system of services, based on local need, provided by emergency medical technicians and paramedics….”  It’s the phrase “based on local need” that drives the CP train.

You see, many of you (particularly the smaller services) are already providing CP services in your communities without having dubbed it with the title “CP.” Maybe you do not do hospital discharge follow-up, but you offer other services in support of your community. For smaller EMS agencies, contracting with insurers or facilities may not fit your needs. Perhaps you would do better with a model like what will be provided (and paid) in Minnesota.

Minnesota expanded their scope of practice to recognize paramedics with additional training in CP.  Best of all, Minnesota’s Medicaid now recognizes AND REIMBURESES for the service; essentially, they pay for treatment without transport. Minnesota’s “covered activities include health assessments, immunizations and vaccinations, chronic disease monitoring and education, collection of lab specimens, medication compliance checks, hospital discharge follow-up care and minor medical procedures approved by a medical director. Community medics must work under the supervision of an ambulance service medical director, who, with an order from a patient’s primary-care provider, then bills Medicaid for the services delivered.” Just think about how many of you are doing some portion (or all) of what is being done in Minnesota.

Interestingly, treatment without transport is a recognized service with its own code as listed on the CMS website (“A0998” located in the list of HCPCs codes in the Public Use file). However, Medicare does not, at this time, reimburse for A0998. But that’s not to say that our industry could not push to obtain MEDICAID reimbursement for treatment without transport, particularly with the anticipated movement of so many patients into Medicaid systems in the coming year. Your individual state may be an easier challenge to obtain recognition for “treatment without transport” than tackling the Federal program of reimbursement.

Consider working with your state ambulance association or other local providers to lobby for coverage of treatment without transport services or other CP services as will be done in Minnesota. Their Medicaid established its own code and level of reimbursement to cover CP services.

Here’s another approach from my home state of Pennsylvania where the Pittsburgh Tribune Review published an article about the CP efforts or Cranberry EMS. “Cranberry EMS is expanding its community outreach with two new programs offering home visits. The Safe Landing program involves having paramedics or EMS technicians make four-hour home visits to new parents. They'll check for proper installation of car seats, conduct a home safety check and show parents the safe way for children to sleep. The cost is $150 for each visit. For the Community Wellness Check program, medics make weekly one-hour visits to area homes. Services include taking and tracking a person's vital signs, making sure they are taking medications properly, assisting with medical questions and performing a home safety check. The weekly cost is $145 for a single person or $170 for a couple for one visit a week; $175 for a single and $200 for a couple for two visits a week; and $200 for a single and $225 for a couple for three visits a week.”

No matter what model a region pursued, they all had a common thread – collaboration with other healthcare providers and community resources to deliver quality outcomes. Remember, I did not say any of this will be easy or happen overnight, but keep the conversations flowing. You are the people who deliver EMS and you know better than anyone what the needs are – both from the service aspect AND your own financial perspective. This is not a daunting task; these are exciting times!

About the author:  Maggie Adams is the president of EMS Financial Services, with over 20 years experience in the ambulance industry as a business owner and reimbursement and compliance consultant. Known for a practical approach and winning presentation style, Maggie has worked with medical transportation providers and billing companies of all kinds to support their billing, auditing, and documentation training efforts. For more info, contact her at maggie@ems-financial.com or visit www.ems-financial.com