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Community ParamedicineNational Rural EMS ConferenceSan Antonio, TexasApril 21, 2016

Gary WingrovePresident – The Paramedic FoundationGovernment Affairs Specialist, Mayo Clinic Medical Transport

Paramedicine and the Paramedic Profession

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• Officer• Corporal• Sergeant• Lieutenant• Captain• Investigator• Chief• Trooper• Detective

• Lieutenant• Captain• Pump Operator

• Driver• District Chief• Inspector• Prevention

Officer• HazMat

Specialist

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• Emergency Physician

• Obstetrician• Anesthesiologist• Cardiologist• Hospitalist

• Orthopedist• Radiologist• Urologist

• CRNA• CNP• CCRN

• PICU RN

• Case Manager• LPN• CPCU RN• Med Surg RN

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National International

EMT Primary Care Paramedic

Advanced EMT Intermediate Care Paramedic

Paramedic Advanced Care Paramedic

(None) Critical Care Paramedic

(None) Community Paramedic

Ambulance Service Paramedic Service

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Canadian National Occupational Competency Profile

Technician

Canadian Paramedic ProfileClinician

Emergency Medical Responder

Primary Care Paramedic

Advanced Care Paramedic

Critical Care Paramedic

Canada - 2015

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Canada – 2025 (Proposed to PAC Board by NOCP/CPP Steering Committee)

Canada – 2025 (Maybe)

Canadian National Occupational Competency Profile

Canadian Paramedic ProfileClinician

Emergency Medical Responder Paramedic (Baccalaureate)

Ambulance Technic ian (notyet vetted) • Critical Care Paramedic

• Flight Paramedic

• Tactical Paramedic

• Community Paramedic

A Tale of Four Nations – Paramedic Profession Regulation

Country College of Paramedics State/Provincial

UK National

Australia Predict 2020 National Currently by each Paramedic Service

Canada Half (increasing) Half (decreasing)

USA None All

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United States

Technician Clinician

EMR (certificate) None

EMT (certificate/diploma) None

AEMT (certificate/diploma) None

Paramedic (certificate/diploma) None

United States – One Possible Transition

EMR, Certi fic ate

United States – One Possible Transition

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2025

Clinical Masters (Paramedic PA?)

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EMR, Certi fic ate

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United States – One Possible Transition

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2030

Clinical Masters (Paramedic PA?)

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Clinical PhD or DrPH

EMR, Certi fic ate

History of Community Paramedic

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IRCP 2016

2005

© 2015. International Roundtable on Community Paramedicine. All Rights Reserved.

2014

• Over 200 Delegates – Biggest IRCP Ever• 7 Countries

• Australia• Canada• England• Ireland• Norway• United Arab Emirates• United States

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A Decade of International CollaborationOur Governments Are Investing

Our Governments Are Investing

• Minnesota - $800,000/$1.5 Million in Shared Savings From CP Indigent Care

• Australia - $4,000,000 CP Workforce Grants• Ontario - $6,000,000 Expansion of CP Programs• United States – 2012, $13,500,000 Innovation Awards for CP

Programs• United States – 2014, $29,200,000 Innovation Awards for CP

Programs

Changes Underway

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How CP Grew Up

• 1990s – New Mexico, North Carolina• 2005 – IRCP• Curriculum

• 2007 - v1 (Minnesota – CHW Roots)• 2009 - v2 (Colorado)• 2012 - v3 (35 colleges)• 2015 - estimate 2,000 CPs nationwide, 1,000 at HTC alone • 2015 - International Exam• 2016 - v4• 2016 - CPT Curriculum

Community Paramedic

• Curriculum version 3• 2015 BCCTPC exam• 2016 update to version 4

• Rebranding• Community Paramedic Technician• Community Paramedic Clinician• (Community Paramedic Practitioner)

Community Paramedic Clinician

• 14-16 college credits• Version 4 2015• Exam 2015

• Primary care integration model

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Community Paramedic Technician

• 4 college credits• 9-1-1 centered

• Treat/no transport• Treat/refer• Treat/alternative destination• Assess & Report

Evaluation

Evaluation

• Master Mind Group• Original Members:

• Matt Zavadsky (MedStar – Fort Worth)• Brenda Staffan (REMSA – Reno)• Dan Swayze (U of Pittsburgh)

• Additions:• Brent Myers (Wake County, NC)• Gary Wingrove (Mayo – Rochester)• Brian LaCroix (Allina – St. Paul)

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Measures

Aim• A clearly articulated goal statement that describes how much

improvement by when and links all the specific outcome measures; what are we trying to accomplish?

• Develop a uniform set of measures which leads to the optimum sustainability and utilization of patient centered, mobile resources in the out-of hospital environment and achieves the Triple Aim® — improve the quality and experience of care; improve the health of populations; and reduce per capita cost.

Measures Definition• 18 Core Measures {“CORE MEASURE” in the description}

• Measures that are considered by the measures development team through experience as essential for program integrity, patient safety and outcome demonstration

• CMMI Big Four Measures (RED)• Measures that have been identified by the CMS Center for Medicare and Medicaid

Improvement (CMMI) as the four primary outcome measures for healthcare utilization.

• MIH Big Four Measures (ORANGE)• Measures that are considered mandatory to be reported in order to c lassify the program as a

bona-fide MIH or Community Paramedic program.• Top 18 Measures (Highlighted)

• The 18 measures identified by the numerous operating MIH/CP programs as essential, collectable and highest priority to their healthcare partners.

18 Core Measures

• Measures that are considered by the measures development team through experience as essential for program integrity, patient safety and outcome demonstration.

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Core Measure Examples

CMMI Big Four Measures (RED)

• Measures that have been identified by the CMS Center for Medicare and Medicaid Improvement (CMMI) as the four primary outcome measures for healthcare utilization.

CMMI Big 4 Examples

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MIH-CP Big Four Measures (ORANGE)

• Measures that are considered mandatory to be reported in order to classify the program as a bona-fide MIH or Community Paramedic program.

MIH-CP Big Four

Top 18 Measures (Highlighted)

• The 18 measures identified by the numerous operating MIH/CP programs as essential, collectable and highest priority to their healthcare partners.

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Top 18 Measure Examples

Resources & A Glimpse Into the Future

Community Paramedic

• MDH funded “employer’s toolkit”• CHW• Dental therapists• CPs

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MDH CP Toolkit

• Phase 1:• Literature review• Compilation of legislation• Survey of practicing CPs• Survey of agencies• ID of existing toolkits• Financial Practices

• Phase 2:• Adjust Phase 3 work plan

MDH CP Toolkit

• Phase 3:• 11.02 Summarized CP scope of practice• 11.03 Summarized existing requirements for obtaining and maintaining

CP certification• 11.04 Identified additional training necessary for transition into the

workplace• 11.05 Identified services that can be, or are, provided by a CP

distinguishing between those services that are reimbursable vs. not reimbursable

• 11.06 Documented comprehensive policies and procedures for billing CP services

MDH CP Toolkit

• Phase 3• 11.07 Summarized salary estimates and ranges for CPs• 11.08 Provided an analysis of the employer Return on Investment (ROI)

in hiring a CHP• 11.09 Documented potential community benefits of CPs• 11.10 Summarized existing models and/or use cases that demonstrated

financial sustainability of using CPs• 11.11 Summarized existing models and/or use cases that illustrate how

CPs can be used as a model to coordinate care for complex patients across settings of care

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MDH CP Toolkit

• Phase 3• 11.12 Summarized examples and models of integrating CPs into ACOs,

IHPs or other shared health care reform delivery models and payment reform arrangements

• 11.13 Summarized examples or models that use CPs to bridge disconnected sectors of the health care system

• 11.14 Collected and compiled copies of applicable documents, specifically break-even and cash flow analyses, pro-forms, and any time studies or task-based analyses describing the basic components of the work for the CP

MDH CP Toolkit

• Phase 3• 11.15 Provided other analyses that a potential employer would find

useful such as: population based payment mechanisms that allow employers to contract their CP staff to a third party; productivity and volume estimates for a CP working in various clinical and non-clinical settings as well as for different types of providers; and, rural and urban differences in Minnesota. Additionally, an up-to-date communication mechanism for tracking continuing education opportunities for CP providers will be completed as part of this task

Resources

• IRCP• CPIF

• www.ircp.info• cpif.communityparamedic.org

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Community Paramedic

• Development of education portal: Mobile CE• National measures committee

Questions & Discussion