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House calls help hospitals reduce re-admittance rates

Leah Borst
Special to The Detroit News
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Shortly after 93-year-old John Lesage was released from McLaren Macomb Hospital for double pneumonia, three paramedics were at his doorstep.

Not because he had a relapse. The crew was there to make sure Lesage understood what he needed to do to stay healthy.

“They helped me with my medications,” Lesage said. “They explained everything to me.”

Lesage is part of a trial program in Macomb County where some patients released from McLaren and Henry Ford Macomb hospitals get regular visits from a Medstar Ambulance Service paramedic crew to make sure patients are following doctors’ instructions and avoid readmission.

Lesage said he didn’t understand all the instructions his doctor gave him before being released. “I think they have saved my life,” he said of the paramedics.

“Once a (hospital) patient is told they are going home, there is a string of people handing them paperwork, giving them new medications and directions,” said Kolby Miller, CEO of Medstar, which is running the trial Mobile Health Paramedic program. “Then, the patient goes home and can’t remember everything.”

The in-home support, the first such program in Macomb County, was prompted by new Medicare rules that say the federal program will no longer reimburse hospitals for patients re-admitted to the hospital within 30 days of discharge for the same conditions.

“One of the highest numbers of readmissions is related to heart failure,” said Chris Starke, McLaren Macomb’s director of clinical organization effectiveness. “Since the program has started, we’ve had zero readmissions of the patients participating in the program.”

“We are a resource that some patients haven’t had before,” Miller said. “Our program helps build the transitional bridge between the patient, the hospital and the primary care physician.”

The program serves patients with chronic heart failure and chronic obstructive pulmonary disease in Medstar’s Macomb County service area. Within a month of discharge, about 24 percent of CHF and COPD patients return to the hospital with symptoms, according to Miller, the majority due to the patients’ failure to follow up with their doctor.

The average cost per hospital visit for a patient with chronic heart failure is $17,000, according to Medicare statistics.

Mobile Health paramedics visit patients in their homes every day for the first two weeks, then every other day for the rest of the month-long monitoring period. The paramedic evaluates the patient’s vital signs, medications and discusses follow up with the primary care physician.

Cost savings potential

In time, the program could offer huge cost savings for the hospitals. Miller estimates it could keep 180 patients from being re-admitted, saving $3 million annually between the two hospitals.

Similar programs are on the rise as hospitals across the nation come up with new ways to reduce readmissions to avoid financial penalties under the Affordable Care Act.

Community EMS in Southfield began a mobile health program with Botsford Hospital to have paramedics visit chronic disease patients before they end up at the hospital. Huron Valley Ambulance is testing a pilot program in Livingston County to determine if ambulance runs could be replaced by paramedic visits for non-life-threatening 911 calls.

The Mobile Health Paramedic program in Macomb has enrolled about 40 volunteer patients since launching in July.

There is no cost to patients because McLaren Macomb, Henry Ford Macomb and Medstar are covering the costs.

Lesage’s daughter, Connie, 64, has lived with and cared for her father since her mother died of cancer three years ago.

“The (paramedics) just talk to him and he listens to them,” Connie Lesage said. “They make him smile. They help with his medications … There’s things he’s stubborn about and they just talk him into it. (The paramedics) treat us like family; I wish we could keep them (longer than the 30-day program).”

Keeps ‘patients on track’

The Macomb County EMS Medical Control Authority and the Michigan Department of Community Health EMS Division approved the 180-day trial program to evaluate its effectiveness. The trial phase ends in December.

“It meets the objective to provide care for the patient and helps keep patients on track,” said Deborah Condino, EMS Medical Control Authority executive director. “EMS agencies — both public and private — are less excited about this program because it may take away some of their business. Yet, if it is done well, it will ultimately reduce the number of transports to the hospital and change the landscape for EMS.”

She said other EMS agencies in the county have shown interest in creating similar programs, but municipal agencies don’t have the same relationships with the hospitals. McLaren Macomb and Henry Ford Macomb co-own Medstar.

“It’s not impossible (for municipal agencies), but it’s different than a private agency already owned by the system,” Condino said.

Miller believes the program eventually will expand into other service areas and cover additional illnesses.

“I like to imagine a day that we can do well baby checks, administer immunizations, remove stitches,” he said. “I think we’ll find that using paramedics is showing a pretty clear look into the future.”

Leah Borst is a Metro Detroit freelance writer.

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