Transcript Mobile Integrated Healthcare in California

Mobile Integrated Healthcare
in California: Pilot Projects
Howard Backer, MD, MPH, FACEP
Director, California Emergency Medical
Services Authority
CA Professional and Legal Climate
Supportive
• State embracing healthcare reform
• Medical system pioneered managed care
• Strong interest among EMS agencies and
providers
CA Professional and Legal Climate
Barriers
• Statutory language for EMS
• Poor understanding of CP/MIH by others
• Carefully guarded scope of practice
– California Nurses Association
– Emergency Physicians
– Home healthcare
CA Health and Safety Code 1797.218
Any local EMS agency may authorize an
advanced life support program which provides
services utilizing EMT-P for the delivery of
emergency medical care to the sick and injured at
the scene of an emergency, during transport to a
general acute care hospital, during inter-facility
transfer, while in the emergency department of a
general acute care hospital until care
responsibility is assumed by the regular staff of
that hospital, and during training ….
Scope of Practice Definitions
• The range of responsibility–e.g., types of
patients or caseload and practice guidelines that
determine the boundaries within which a
physician, or other professional, practices.
• Practices, procedures, actions, and processes
that are permitted for the licensed individual.
• That which the law allows for specific education
and experience, and specific demonstrated
competency.
Scope
vs
Role
Does it make a difference?
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Patient assessment
Vital signs
Point of care testing
Medical direction and
protocol driven care
Expanded Assessment
Non emergency
management
– Home visits
– Diabetes, asthma, CHF
– medications
Administer medication
– Orally
– Intramuscularly
– Intravenously
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Triage and referral
Follow up ED
Follow up hospital d/c
Home safety inspection
Issues for Mobile Integrated Healthcare
• Increased responsibility and decision making
• Turf issues with other health care personnel
– Role versus scope
• EMS role identity
• Medical model
– Speaking the language of health care
– Patient safety and quality assurance
• Increased integration of EMS with other parts of
health care system
Requirements for any CP Program
• Training program appropriate for tasks
– Selection criteria for personnel to train
• New models of reimbursement
– Currently pay for transport only
• Health information technology and exchange
– Data collection and information sharing
Maine Statute
Sec. 1. 32 MRSA §84, sub-§4
Establishment of community
paramedicine pilot projects
Effective August 30, 2012:
Using the same process … for using pilot projects to
evaluate the workability and appropriateness of
incorporating a particular emergency medical treatment
technique or a type of equipment into any licensure level,
the board may establish up to 12 pilot projects for the
purpose of developing and evaluating a community
paramedicine program.
A pilot project established pursuant to this subsection
may not exceed 3 years in duration.
Health Workforce Pilot Projects
CA Health and Safety code Section 128125
• improve the effectiveness of health care delivery
systems… to utilize health care personnel in new roles
and to reallocate health tasks to better meet the health
needs of the citizenry.
• experimentation with new kinds and combinations of
health care delivery systems
• health workforce pilot projects should be exempt from
the healing arts practices acts
• accountability of projects to public health, safety, and
the career viability of persons trained in these programs.
• incorporate innovations developed in approved projects
that are likely to improve the effectiveness of health care
delivery systems.
Health Workforce Pilot Program
• Allows statutory and regulatory waivers needed
for expanded scope of practice
• Can test a variety of project options
• Demonstrates feasibility in CA healthcare system
• Assures patient safety and data to demonstrate
benefit and lack of harm
• Provides strong evidence for legislature if
successful programs
• Creates partnerships that may support needed
changes for permanent program