By-the-Numbers: biggest users of Clayton County’s Fire and Emergency Services
Residents in Clayton County: 259,424*
Highest users of the county EMS: 35
Number of annual trips highest users make to the ER: 600
Their age range: 20 years old to 92 years old
What those residents cost the county in one year: nearly $1.5 million
Number of residents transported to hospital between 11 and 20 times in a year: 26
What those residents cost the county: $875,000
Number of residents transported to hospital more than 21 times in a year: 9
Their cost to the county: $612,000
Residents transported to hospital 36 times in a year: 1
Cost to launch Community Care: under $100,000
Cost to buy and equip vehicle for the program: $48,000**
* 2010 Census
** A grant from Kaiser Permanente paid for the vehicle and equipment.
Source: Clayton County Fire and Emergency Services.
Over the past year, Clayton County’s emergency medical services has transported the same 35 residents to the hospital 600 times for treatment for asthma, diabetes, high blood pressure and other ongoing medical conditions, a county official said.
While chronic illnesses often aren’t viewed as emergencies, many of the patients don’t have any other access of health care except hospital emergency rooms, said Landry Merkison, Clayton’s fire chief and emergency management services director.
The chronically ill — or "Frequent Fliers" as they're known in EMS parlance — cost American communities hundreds of millions of dollars a year. In Clayton, county taxpayers have paid nearly $1.5 million getting just those three dozen folks to the emergency room.
And the problem is more widespread.
“A lot of our citizens don’t have a primary care physician or a regular doctor,” said Merkison. “Access to health care is difficult for them and a lot of times they have no other option but to call 911.”
This week, the county is launching a pilot community paramedicine program through its fire and emergency services department to counter the problem.
Clayton’s new Community Care program cost “well under $100,000” to launch, said Merkison who approached county officials with the idea about a year. Merkison’s department worked for eight months with Southern Regional and Kaiser Permanente developing the program. Kaiser provided a $48,500 grant that was used to buy and equip a vehicle. The team consists of a critical care paramedic, a behavioral health specialist, a social worker and a volunteer nurse who will go on each run.
The program is one of the few paramedicine programs in U.S. run by a fire department, according to Karen Pearson, policy analyst with the University of Southern Maine which has studied community paramedicine programs nationally and is monitoring Maine’s 12 pilot programs. Most programs are run through private ambulance services or hospitals that own ambulance companies, Pearson noted
“Clayton is unusual,” Pearson said. “We have not seen many fire department-based community paramedicine programs.”
Socioeconomic changes and cuts in federal Medicare and Medicaid - the source of reimbursements for many EMS -in recent years have left Clayton, like many communities, struggling. The ER and EMS has become the go-to remedy for many of the community’s uninsured and chronically ill.
“Our goal is to reduce that dependence on the ER, ” Merkison said.
Here’s how Clayton’s program will work:
Starting Monday, the Community Care team will begin making appointments to meet with the 35 targeted residents with chronic conditions. They’ll be told about the program.the team will work with those who choose to enroll, monitoring medicines and educating them about their disease and diet.
Initially, the team will visit a patient two to three times a week to check progress and fewer times once the illness is under control.
“They will do initial assessments for each patient and help us get a good picture of what we’re dealing with and what we can manage,” Merkison said. “If they have a physician, we’ll work with the doctor to help manage their condition.”
The program would help steer those without doctors to various health care programs that would help them find health care providers.
Community paramedicine programs have been around for about 40 years but started getting the attention of state and federal agencies in the mid-1990s, Pearson said. Communities such as Canton, N.J., Abbeville, S.C., and Dallas are running successful programs. In metro Atlanta, Grady and Spalding Regional Hospital have paramedicine programs.
Spalding tested the concept last October before launching it in February. The hospital has a full-time community paramedic who visits the chronically ill weekly.
“We realized this is a situation facing a lot of hospitals, and we had a unique position where we own the EMS,” Spalding Regional spokeswoman Kathleen Smith said. “We had trained health care personnel who are out in the community who could help see if this program will help reduce the number of times a chronically patient visits the hospital as an in-patient for the same condition.
Smith estimates the program will help about 100 people over the next year.
Merkison believes helping the chronically ill get their health conditions under control will ultimately lead to an overall healthier medical delivery system in Clayton.
“I’m not saying I can fix the system in the next 12 months,” Merkison said. “But if I can prove this system works, I can save not only the county money and Southern Regional money but ultimately Medicaid and Medicare money.”
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