It seems so simple, you wonder why it hasn't been tried before. Home health-care agencies face a growing shortage of trained professionals. Fire agencies providing EMS services to their communities already devote a significant share of their budgets to maintaining EMS capability. Might this be an opportunity knocking? Fire Chief Dan Hermes of the Pleasantview Fire Protection District in Chicago's western suburbs thinks so, and his district is poised to roll out a unique program: using off-duty paramedics to deliver home health-care services to area residents.
What was the genesis of the concept?
This actually started a few years ago. PFPD employs firefighter/paramedics to staff its ALS engines and contracts with Paramedic Services of Illinois to provide additional firefighter/paramedics to staff PFPD transport units. PSI's president, Earl Field, and I both felt there was an opportunity for paramedics in the fire service to do more, and we'd been exchanging thoughts regarding a more proactive paramedic force….
This country is facing a well-documented nursing shortage. And Baby Boomers are going to be hitting the age where they'll be placing more of a demand on the health-care system. Hospitals are overcrowded. Medicare is cutting funding. With all of this going on, it seems like now is the right time for our EMS to step in.
When you look at fire departments and fire-based EMS, the EMS component is already consuming 60%-65% of costs in most departments, and sometimes higher. We're providing the service, but we're only being reactive. With this talented work force of paramedics we have, why don't we become more proactive?
I presented the concept at the IAFC EMS Section meeting in early 2005. They said it absolutely made sense. So, I presented the idea to the executive board of the Illinois Association of Fire Chiefs, and the board, too, gave the idea its support.
At the same time, Earl Field had been busy as well. He had already contacted our regional hospital, Good Samaritan Hospital in Downers Grove. The project medical director at Good Samaritan embraced the concept whole-heartedly.
The Illinois Department of Public Health assured us that as long as we were working within standard operating guidelines developed by the project medical director, and using skill sets that paramedics are trained in, then we would, in fact, be within our scope of practice. Finally, we went to the Illinois Home Care Council. At first, the organization was very hesitant. I think there may have been a concern over the paramedics usurping what traditionally has been the territory of nurses. But after considering it, they realized we weren't trying to encroach on the nurses; we were actually trying to fulfill a need. And they've now embraced the concept, too.
So it's a case of the right idea at the right time?
For certain. Of course, there are financial implications, too. We will actually be a subcontractor to the home health-care agencies. We'll get our calls from the agencies on Monday for what they will be needing on Tuesday, and so on. They'll pay us directly — we won't be billing the patients. And that's why one of the things we had to make sure of was that the Illinois Department of Public Health gave us its blessing, so Medicare will cover this. And it has no issue with us being subcontractors as long as we're within our scope of practice.
What makes it attractive to the home health-care agencies is that in many cases they already have to contract out to other agencies that are charging a pretty health sum. Our fees will be less than that, probably more in line with what they would pay regular staff nurses, if they had them, because we've already absorbed the overhead and benefits associated with our paramedics.
Will all your paramedics be involved?
Our intention is to involve those paramedics who want to participate and who qualify; not everyone is suited for home health-care work — it takes a certain demeanor. But those of our staff who want to do it, and who qualify, we'll pay them on their days off at a time-and-a-half rate. Like I said, it doesn't mean we have any more overhead and benefit costs. The home health-care agency gets a good price and fire department generates more income. It's win-win.
What's the next step?
Right now, we're trying to get some other districts and departments involved so we can have a good-sized demonstration program. We're going to start training 10 of the paramedics right away. Then it's just a matter of the home health-care agencies saying, “OK, let's get started.” That may be a couple months away yet. After that, I think within six months we will be well on our way to proving the concept works.
