Most of us may think of a paramedic as a healthcare professional who works primarily in a pre-hospital environment, usually as part of an emergency medical services (EMS) team. That is changing. Hospital executives are laser focused on readmissions, especially for congestive heart failure (CHF) patients. CHF is the number one reason for hospital admissions. Typically, CHF patients express symptoms of ankle swelling or dizziness, are sent to the ER, become admitted to a cardiac floor of the hospital, stabilize, and are discharged in a few days. Within 30 days, 25% of them are readmitted with the same symptoms as before. Readmissions are costly and produce a negative quality of life for patients and families.
The Centers for Medicare & Medicaid Services (CMS) has been implementing financial penalties for hospitals with above average readmissions. Hospitals are now taking proactive steps to prevent unnecessary readmissions. One of the measures is to deploy paramedics to the residence of a CHF patient instead of the standard practice of dialing 911 and sending the patient to the ER. Paramedics can often intervene for the patient and prevent hospitalization. For example, he or she might inject a diuretic to reduce swelling of the ankles.
A WSJ article this week said that Avoiding the hospital is good for everyone — including hospitals (see Paramedics Aren’t Just for Emergencies). Under the rapidly expanding Accountable Care Organization (ACO) model, hospitals get a fixed reimbursement per patient for those in their care. Under the new model, readmissions generate no additional revenue, but they do generate additional cost. This is a 180 for hospitals and is a win win for all.
If you are interested in CHF and hospital readmissions, see Health Attitude. If you are deeply interested, please see my doctoral dissertation:
Cardiac telemonitoring for the reduction of hospital readmissions for congestive heart failure patients, by John R. Patrick, March 28, 2014.