Officials from Mesa’s fire department envision a future where employees could visit medical patients at their homes as a follow-up call at the request of their doctors to reduce the need for emergency transport to hospitals.
“(It) would allow us to provide some offsetting revenue where it was available through insurance coverage for some of the services that we provide,” Fire Chief Harry Beck said at a city council study session June 16. “Case in point, we have been approached by several private medical companies including doctors groups and have been asked to look into their patients post-surgical to be sure that they are not going to have a reoccurrence of an injury that would require admission or hospitalization,” he said.
“They see that in their best interest – clearly it is financially as well as patient care. We see that in our best interest in that we know that 25 percent of all the advanced life support calls that we run on today are with patients who have been in the hospital within the last 30 days,” Chief Beck said.
If the fire department added the service it would help doctors and reduce emergency trips to the hospital, he said.
“We can kind of support doctors groups, hospitals with their concerns and we can avoid, essentially, a 9-1-1 response – the whole issue of the seriousness of putting a big fire truck on the road for a code-three response for something that we could have avoided,” he said.
The department is looking to the future with emergency-medical-service prevention programs, he said.
“Try to do some things before the issue becomes so acute that we have to respond red-lights-and-siren and can actually get out and help people where we have the ability to predict they are going to need us in advance,” Chief Beck said to the council.
Mesa City Council members at the study session showed support in allowing city staff to draft an ordinance. Those in attendance were Mayor Alex Finter; Councilman Dave Richins, District 1; Councilwoman Terry Benelli, District 2; Councilman Dennis Kavanaugh, District 3; Councilman David Luna, District 5; and Councilman Scott Somers, District 6. Vice Mayor Chris Glover, District 4, arrived at the study session after the discussion and council consensus.
Not a transport service
The ordinance would not include the Mesa Fire and Medical Department transporting patients to the hospital, Jacqueline Ganier, assistant city attorney II, told the council at the study session.
The city of Mesa contracts with Southwest Ambulance to transport patients to the hospital. The ambulance provider is paid by the patient or the patient’s insurance company. The city is in the last of a three-year contract that ends August 2014 and includes two three-year renewal periods, according to the minutes of the Aug. 26, 2013, Public Safety Committee meeting.
Ambulance services receive a Certificate of Necessity from the state of Arizona to charge for their services, Councilman Somers said prior to the vote. He asked how the city would collect and from what entities.
Chief Beck said that if a doctors group asked for the service, the department would contract with the business for the service.
“And that is specifically the type of service that this ordinance would support: at least allow us to engage in this discussion, negotiate some sort of terms that were positive for both groups and move forward,” Chief Beck said.
Private insurance companies could also be billed for services provided in the future, Chief Beck said.
“We’re not looking at this as a wholesale opening to charge for all of our services. We are going to be very selective about this,” Chief Beck said to the council.
The majority of the patients the department assists are on Medicaid or the Arizona Health Care Cost Containment System and would not be charged for services. Medicare insurance could pay for the services, Ms. Ganier, assistant city attorney II, told the council.
Fire and medical department
As its name suggests, the Mesa Fire and Medical Department provides medical- and fire-response services. It also provides fire and life-safety education, fire prevention and emergency management services, according to the city of Mesa’s website.
Medical-services calls are also assigned to a Transitional Response Vehicle program begun in 2007 and Community Care Response Units program begun in 2013, according to a slide presentation posted at the city’s website.
The department has had success in using a TRV staffed with a captain paramedic and firefighter and sent to low-acuity, first-aid 9-1-1 calls for service, Fire Capt. Steven Ward said to the council at the study session June 16.
Lower-acuity patients would not likely need to be transported to a medical facility for treatment, Chief Beck said.
“What we’re looking for are patients who we can predict with high probability will not need to be transported to a hospital and certainly not have a life-threatening injury. In that event, we can send a TRV unit in lieu of a full advanced life support unit to deal with that patient,” Fire Chief Beck said to the council. “We do maintain contact with that patient to be sure that the conditions don’t change on the scene. Anytime there’s any kind of question on the level of medical need there, we’ll go ahead and upgrade to a full advanced life support response.”
Using a TRV allows the department to use its larger units for advanced life support and structural-firefighting-type calls, Capt. Ward said. The department’s two TRV units are operated at peak times, he said.
The department also has two Community Care Response units. One is staffed with a nurse practioner and an advanced life support captain and handles lower-acuity calls like the TRV units.
The other is a behavioral unit staffed by a captain paramedic and nurse practitioner or behavioral health specialist who treat patients and refer them to appropriate care providers.
“We’ve been able to send our crisis counselor out and our paramedics out and they are able to assess these patients and get them to appropriate behavioral care in a much quicker time than they would alternatively,” Capt. Ward said.
Without the use of the department’s behavioral unit, a patient would be transported to an emergency room, which could be a two- to three-day stay while waiting for a crisis counselor assessment and placement in a behavioral facility, according to a slide used in the presentation to the council.
Many on Medicaid, AHCCCS
Mesa Fire and Medical Department data shows that between 75 percent and 80 percent of patients that Mesa’s TRVs or CCRs are sent to are on Medicaid or AHCCCS, Chief Beck said.
“What we’re talking about with this ordinance is really dealing with no more than the 20 percent of the patients that we would encounter,” he said of the proposed program to visit post-surgical patients.
Mayor Finter said the proposed program is innovative.
“We’re already responding to these patients. We have been traditionally doing a code-three, big trucks, lots of people. And we are doing the new TRVs and these Community Care Response units. They are going to save the citizens money and we’re looking for the opportunity now through this ordinance to be able to cost-recover where we haven’t been able to in the past to be able to recover some of those costs. Is that about it?,” Mayor Finter said during discussion of the proposed ordinance.
“That’s exactly correct, mayor,” Chief Beck said in response.
“It sounds pretty innovative to me,” Mayor Finter said.
“The service that the chief is proposing to employ doesn’t even exist today in any model,” City Manager Chris Brady said during discussion of the proposed ordinance. “This is going outside of that emergency call. This isn’t being prompted by a 9-1-1 call. This is a follow-up call that a medical provider asked us to provide to make sure somebody is taking their medications or they’re doing all the follow-ups. It’s a preventative program.”
“Everything that we have done to this point and everything we’re planning to do directly affects the quality of care for the citizens of the city of Mesa,” Chief Beck told during discussion of the proposed ordinance. “The revenue aspect of this is just being a smart manager. If there’s an opportunity to generate some revenue that could offset some of the costs of this we would be amiss if we didn’t pursue this.”