At the dawn of EMS, ambulances were only paid to transport patients to emergency departments. Unfortunately, this unidimensional model still dominates.
However, the pre-hospital environment is no longer “pre-.” It has become its own tier of healthcare. With this evolution of EMS, there are new ways to generate revenue with a community paramedicine program.
Community paramedic programs should be reimbursed and compensated for their hard work. Below, we’ll discuss the differences between reimbursement and revenue. Then, we’ll discuss four ways to generate revenue with your community paramedic program.
Reimbursement and Revenue for Community Paramedicine
Being reimbursed for your work means that you are refilling the created deficit. However, creating revenue involves being paid fairly for a value provided to someone else.
Traditionally, emergency medical services haven’t been aggressive about increasing their income. However, services around the country, both private and government-based, realize the importance of improving their funding.
Community paramedicine will fail if EMS services can’t recruit (and retain) paramedics, cover their expenses, and meet obligations for 911 coverage and interfacility transports. All these goals require revenue.
But, where’s the money?
That’s the question we’ll answer below. As you’ll see, if you find the value, you find the money.
Community Paramedicine Is a Valuable Resource
When asked, “what do EMS and mobile integrated healthcare do to provide value?” the standard answer is often along the lines of “they help people.” While this is both noble and true, it’s too broad a brushstroke when discussing financial stability.
Make no mistake – community paramedicine provides real, money and health-saving value to others. Below, we’ll talk about this and then show you how to create a bridge between the value and the revenue.
Here are several ways community paramedicine creates value:
- Offsetting costs
- Reducing uncompensated expenses
- Taking referrals
- Risk reduction (also known as actuarial risk)
We’ll talk about each of these benefits provided by community paramedic programs. Then, if you’d like, you can watch a presentation that offers a spoken lecture on the subject of improving revenue.
Offsetting Costs with Community Paramedicine
In many situations, community paramedicine provides an offset on healthcare costs. For example, suppose it’s less expensive for a health system to visit a patient and provide preventative care at home. In that case, this organization should reimburse the community paramedicine team for saving their organization money.
This also comes in the form of reducing hospital readmissions. When patients are frequently readmitted to the hospital, Medicare may withhold a small portion of the reimbursement. So, by reducing the number of patients admitted (in a given period) to that hospital, the chance for full reimbursement improves.
However, hospital reimbursement can be a loaded issue, as some hospitals may not have any concerns about frequent readmission, or they may be in an area where this is a much smaller issue.
To learn more, read the Center for Medicare and Medicaid services page on the Hospital Readmission Reductions Program.
With that said, this is only the peak of the iceberg of ways community paramedics provide value to healthcare. Below, we’ll talk about reducing uncompensated expenses.
Community Paramedicine Reducing Uncompensated Expenses
EMS organizations often care for patients who call 911 frequently and utilize resources but will not be a reliable source of reimbursement. This discordance creates a net negative revenue stream, and it happens for several reasons.
First, it could be a common patient who needs care at home but does not want to be transported to the hospital – as in hypoglycemia patients or drug overdoses. But, as we said, if the patient doesn’t go to the hospital, then a large chunk of reimbursement potential is removed from the EMS organization.
Second, that patient may not be a reliable payer, even if they are transported to the hospital. Or the insurance company may not feel the transport was medically necessary, leaving the ambulance on its own.
Community paramedicine can reduce these types of patients. This makes it less expensive for insurance companies and reduces the deficit for the EMS organization itself. In the next section, we’ll discuss why EMS departments and community paramedic programs provide value.
Community Paramedicine and Referrals
If an organization is referring their patients to your programs, you shouldn’t have to cover the entire cost of the patient. For example, suppose a rehab institution decides it’s beneficial for their patient to receive regular care from community paramedicine. In that case, your EMS organization should be reimbursed for your role in caring for that patient.
Often, they refer the patient because they are expensive to care for – there’s no reason your ambulance service shouldn’t receive reimbursement and compensation for taking on these patients.
There are large amounts of money in the form of grants and programs dedicated to improving various areas of public health. As EMS expands its scope into community paramedicine, MIH-CP programs should have access to these funds.
Let’s talk about one of the most powerful ways community paramedicine offers value.
Community Paramedicine and Risk Reduction (Actuarial Risk)
When insurance companies set their rates, they need to assess the client’s risk. Essentially, how likely is the person to need their services?
In many ways, community paramedicine can reduce the likelihood that a patient has an adverse health event. This is a direct benefit to many health insurers. Below, we’ll discuss four common risks you can mitigate with a solid mobile integrated healthcare program.
Here are the four ways community paramedicine reduce actuarial risk:
- Reducing harmful habits
- Maintaining medication compliance
- Environmental improvement
- Improved nourishment
Let’s look at this in a little more depth. Then, if you’d like, take some time to learn more about actuarial risk.
Reducing Harmful Habits
We all know that overconsumption of things like nicotine, alcohol, and narcotics can harm patient health. As such, insurance companies view these behaviors as risky.
Suppose a community paramedic program proves they’ve reduced someone’s smoking habit or that their program helped someone rehabilitate from constant substant abuse. In that case, the insurance companies view this as a net benefit.
However, substance abuse isn’t the only area community paramedic programs reduce risk.
Improving Medication Compliance
Community paramedics who can help patients remain compliant with their medications provide a considerable value. Unfortunately, as many clinicians know, a group of patients lacks the resources to stay current on all their prescribed medications. In many cases, this can create a massive gap in the patient’s health and increase the risk for the insurer.
Sometimes, patients are unable to fill prescriptions at the pharmacy. Other times, their mobility and eyesight are so poor that they have trouble keeping their medications straight.
When a community paramedic comes in and helps that patient stay regular on their medication, they improve that person’s life and reduce the likelihood that the patient will be an insurance risk.
Let’s talk about reducing environmental risks.
Some patients are more likely to suffer a fall than others. Though a fall is only inconvenient for young and healthy people, a fall can be a serious event for someone with comorbidities. In addition, falls are a significant cause of hospitalization in older adults.
A community paramedic program is in the perfect position to reduce the risk of falls in the bathroom, front porch, and hallways. And, if the EMS teams can show that they reduced this risk, they can expect compensation for this valuable service.
Better Patient Nourishment
On a less obvious note, many patients lack the means and resources to maintain healthy nutrition. For as much coverage as bad habits like smoking and drug use receive, there is much less outcry over dangerous eating habits. As a result, many of these patients are simply not getting the nutrition they need to maintain their bodies.
If a community paramedic program can help a patient maintain regular nutrition, it will reduce the likelihood that a patient will have chronic diseases.
Here’s the million-dollar question: how do you take these good things and turn them into currency?
The Bridge Between Value and Compensation
Data is the answer. The way to create value and increase your revenue is to prove that your programs will reduce their risk and save money, particularly when discussing actuarial risk.
Having a history of data will prove that your program can take a patient who is non-compliant with their medications and turn them into someone who stays current on all their prescriptions. The same goes for reducing ‘harmful habits’ or improving a patient’s nutrition intake.
When you have the data, you can go to insurance companies, patients, and hospitals and show them clearly: our community paramedic program can save money and improve health. After establishing these partnerships, you can increase your community paramedic programs’ revenue, and improve the lives of patients.
Julota provides a software solution that connects community providers and allows your EMS program to build a data record that improves your opportunity for better funding, loyal partners, and positive patient outcomes.
To learn more, contact Julota for a full demonstration.