Paramedics branch into home care

Paramedic Ruben Torres will undergo training at EasCare LLC, one of several Massachusetts ambulance companies that plan to branch into home health care.Suzanne Kreiter/Globe staff/Globe staff

Patients of a certain age might remember a time when they didn’t have to leave home to receive basic medical care, like treatment for a fever or cough, and emergency rooms were places to go only in the event of an actual emergency.

Several Massachusetts ambulance companies hope to bring back that quaint concept from long ago by branching into home health care. They plan to send paramedics to treat patients where they live instead of taking them to hospitals, a fundamental shift in how emergency medical services are delivered.

The idea is to expand the paramedic’s role to a provider who not only responds to emergencies but also helps prevent them, treating patients with infections, minor wounds, injuries from falls, and problems associated with chronic diseases like diabetes and congestive heart failure. It could reduce unnecessary emergency room visits and hospital stays, which can cost thousands of dollars.

“We really do believe this is the new house call of the future,” said George Gilpin, chief executive of the Dorchester ambulance service EasCare LLC.

EasCare is poised to become one of the first ambulance companies in the state to provide such home care, launching a pilot program this summer with 2,000 patients of Commonwealth Care Alliance, a Greater Boston network of providers that serves the elderly, poor, and disabled. The program is expected to get approval from the state Department of Public Health soon. Several other ambulance companies are also seeking permission to offer home care services.

The move toward paramedicine, or integrated mobile health care, comes in response to state and federal laws — including the Affordable Care Act — that are pressuring the health care industry to control costs. The Centers for Medicare and Medicaid Services, the federal agency that insures the elderly and the poor, last year imposed penalties of $227 million on hospitals with high rates of patient readmission, down from $280 million in 2012.

Private insurers, also aiming to keep costs down, increasingly offer incentives to providers for keeping patients out of the hospital when possible.

For ambulance companies, home care represents a new source of revenue at a time when their core business is being squeezed by government and insurance company efforts to discourage costly emergency room visits and hospital stays.

Paramedics already play a role in home care in other states, including Texas, Colorado, and Minnesota. EasCare’s parent company, Medavie EMS of Dartmouth, Nova Scotia, provides home care in the Canadian province. Medavie’s pilot program showed that paramedic care eliminated emergency room visits for 73 percent of 135 seniors treated over nine months in 2011.

The largest ambulance company in the United States, American Medical Response of Greenwood Village, Colo., has used paramedics to provide home care since 2010, starting in Arlington, Texas. It has since launched similar programs in more than a dozen cities and plans to expand the practice into Massachusetts, where it operates in 11 communities.

The emergency medical services industry has a wealth of knowledge about how patients get sick and injured at home, said Dr. Edward Racht, chief medical officer at American Medical Response. “We’re turning that around and saying, ‘Let’s improve care, let’s fix it before it happens,’ ” he said.

How ambulance companies deliver home care services vary. In some programs, they respond to calls from patients or providers. In others, they make scheduled visits, following up, for example, after patients are released from hospitals to ensure they take medications and adhere to doctors’ instructions.

EasCare, which plans to train as many as 10 paramedics to provide home care, will rely on referrals from its partner, Commonwealth Care Alliance. The network already maintains phone lines for patients to call for overnight problems. Staff provide whatever help they can, calling an ambulance if they think the patient needs to go to the hospital.

Now they will have another option: sending a paramedic.

EasCare paramedics would travel to these calls in a sport utility vehicle carrying medications and equipment, such as for performing blood tests, that regular ambulances don’t have. With access to electronic medical records, they would assess patients and contact their regular doctors before beginning a plan of care.

If they determine a patient needs to go the hospital, they call an ambulance.

“This really changes the whole way EMS is going to approach patients,” said Greg Davis, project manager at EasCare. “Sometimes we wondered if we really needed to take them to the hospital. Is there something we could have done for them in their home? This will give us that opportunity.”

Fallon Ambulance Service of Quincy is seeking state approval of a home care program aimed at preventing a common cause of injury for the elderly: falls. In Fallon’s program, paramedics would survey homes for fall risks and make suggestions to fix them.

“That data is then shared with their primary care physician, or whoever’s managing their care,” said Patrick Tyler, chief operating officer at Fallon. “That closes the loop.”

But Pat Kelleher, executive director of the trade group Home Care Alliance of Massachusetts, said it is unclear how paramedicine programs would work and whether they would help patients.

“We question whether [paramedics] — even with additional training — would be able to provide ongoing home-based care of the type that these complex high hospital-risk patients need,” she said in a statement.

The typical paramedic trains for 1,300 hours. EasCare requires another 300 hours of training for the medics who will be making home visits. Home health aides receive 75 hours of training but usually work alongside nurses.

Massachusetts has no specific regulations concerning paramedics providing home care services, so the Department of Public Health must approve the programs case by case. State health officials are generally supportive of the concept, which they believe “has the potential to both contain medical costs and enhance patient care,’’ said David Kibbe, department spokesman.

Insurance companies have not developed payment schedules for home services provided by paramedics. EasCare will be paid through its contract with Commonwealth Care Alliance (the companies didn’t disclose terms). Fallon has not announced any contracts yet. But both companies plan to collect data from their pilot programs to help design payment structures.

“In terms of the quality of care we will be able to deliver, it’s a game changer,” said Dr. Toyin Ajayi, hospitalist medical director and director of transitional medicine at Commonwealth Care Alliance. “This is one of those innovations in the way we deliver health care that passes the common sense test.”