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Alabama’s Health

Can rural Alabama benefit from community paramedicine?

Community paramedicine is an emerging healthcare profession where paramedics and emergency medical technicians also provide routine healthcare services. This concept has been used for several years in rural areas with a shortage of primary care services. Minnesota is a leader in this concept, signing a Community Paramedic Bill into law in 2011. Alabama does not have a rural community paramedic program, but does have three such programs in Birmingham, Mobile and Tuscaloosa.

Initially, rural community paramedic programs expanded the services provided by rural emergency medical services (EMS) personnel to include outreach, wellness, health screening assessments, dispensing immunizations, disease management, mental health assistance, wound care, safety programs, properly taking medications, and assisting physicians in rural clinics and hospitals. This has provided needed primary care service in many rural areas. It also has the potential to better utilize the abilities of EMS personnel when they are not answering emergency calls and could provide additional revenue to help fund rural EMS and decrease future health care costs.

Community paramedicine also could decrease the excessive number of non-emergency ambulance transports to emergency rooms. The Alabama Legislature funded $500,000 through the Alabama Medicaid Agency for a pilot project involving the City of Tuscaloosa and the University of Alabama’s College of Community Health Sciences for such a program. Through this pilot project, nurse practitioners or physician assistants ride with other first-responders on what appear to be non-emergency calls and offer treatment at the patient’s home. Tuscaloosa Fire and Rescue Service has provided highly innovative community paramedic service since 2014.

The Affordable Care Act (or Obamacare) increased hospital responsibility in preventing the readmission of Medicare patients by adding provisions to the Social Security Act that restricted payments to hospitals for Medicare patients who had to be readmitted within 30 days following discharge. Hospitals have not traditionally served as caretakers outside the hospital, but are now placed in this role for Medicare patients. Several medical centers are using community paramedics for case managers for discharged, high-risk Medicare patients to assure that patient instructions are followed and decrease the likelihood of readmission.

The City of Mobile Fire-Rescue Department is operating a community paramedic program to prevent such readmissions and keep hospital beds available. This service involves assessment, taking vital signs, taking medications properly, following other physician or hospital instructions properly, etc. This service is being provided without reimbursement.

The only other community paramedic program in Alabama is operated by Birmingham Fire and Rescue. This program is patterned after the rural community paramedic concept in rural Minnesota and seeks to prevent unnecessary emergency room visits and free hospital beds by preventing readmissions. None of the three community paramedic services serve rural areas.

There are rural areas in Alabama that may benefit from having a community paramedic program. Several issues must be addressed before this can be done. There must be reimbursement by private insurance, Medicare, Medicaid, and other payer sources for services provided. Community paramedicine should not duplicate services better provided by others, such as home health. Additional training may be required for EMS personnel to expand health care activity. Providing routine healthcare services differs from providing emergency services and may require EMS personnel.

Visit the Rural Health Information Hub at www.ruralhealthinfo.org and enter “community paramedics” in the search box. You can also contact the directors of the three programs in Alabama.

Dale Quinney is executive director of the Alabama Rural Health Association, 1414 Elba Highway, Troy, 36081.