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By Francis Koster, Ed.D.

Some of the most costly health care delivered in the United States starts with a call to 911. This triggers an expensive ambulance run, which usually results in an expensive emergency room visit. After recovery, the patient goes home — and often starts the cycle over again with another call to 911.

One role model worthy of learning from in this arena is MedStar, a public utility model ambulance system serving 15 towns in the Dallas/Ft. Worth Texas area. They have figured out how reduce the number of calls to 911, how to respond quicker, how to have a more highly trained ambulance crew and improve patient care — all while reducing total health care cost.

Here are a few of their techniques.

They matched the fleet to the need. MedStar examined how often calls for help came in, and from where. They found the majority of calls came during two peak times of the day but staffing schedules had the same number of trained people standing by in ambulance garages 24 hours a day. By making the shifts 12 hours, instead of the previous 24 hours, and overlapping shifts, they were able to have 50 percent more crews standing by during the peak call time. This resulted in faster response times and much lower payroll.

They also moved the “on-duty” ambulances depending on the time of day, placing them where the history indicated calls would come from at that time, instead of having them sit in a garage or fire station. Think of it as defensive football. If you know a pass is coming, you deploy your defense against it. Again, shorter response times.

To deal with “frequent riders,” MedStar did an analysis of who called for the ambulance and for what. It found that 21 of the most frequent callers resulted in nearly 1,000 ambulance calls in one year. These frequent riders amounted to $1.1 million in ambulance charges and nearly $2.5 million in emergency room charges. Reducing calls from frequent riders for the entire Ft. Worth area would save a lot of health care time and money, and the patient would be healthier. And taxes could decline.

Armed with this list of “frequent flyers,” MedStar assigned a paramedic on “light duty” due to injury to make what amounts to house calls to check on the patients. These house calls uncovered a lot of circumstances that would have resulted in further calls for help if not addressed. As a result of such intervention, the use of the ambulance service by these callers declined 51 percent.

Another technique that helped was to simply review with the frequent riders the cost of the ambulance and hospital. Many of these folks often had no idea of the cost, and some changed their behavior when educated.

MedStar did research on their assumptions to check them out and found some surprises. Research demonstrated that “running cold” (no lights or sirens) instead of screaming down the road did not increase the time from the first call to the arrival at the hospital, but did allow for the EMT crew to tend to the patient better (putting in needles, and so forth) , because neither the patient nor the EMT were thrown from side to side when brakes were applied or abrupt turns occurred. The patient arrived in better shape without sirens.

MedStar got proactive. The ambulance service had a high percentage of calls to large gatherings where mature guests suffered heart attacks and medical people were among the guests, but the event hall had no defibrillator. MedStar allows party planners to request the loan of a defibrillator to have on hand, thus raising the chances of a heart attack victim’s survival.

They made getting training easier. When the crews were on call but not busy, they were given access to training via electronic distance learning. If an hour passed with no emergency, the crews were in school.

The system, which started covering solely Fort Worth and grew as other area cities recognized the value of joining a regional system, now numbers 55 ambulances and 325 employees. It has more than 200 licensed, highly trained EMTs and paramedics, with a large number holding advanced certification due to the “training while waiting” plan.

With all the discussion about saving Medicare, you don’t need to be a futurist to see that unless something sensible is done to improve our health care “non-system,” we will either bankrupt our country or deny millions health care. It does not need to be that way. You can help bring about change by helping community leadership study successful models already in place elsewhere that improve health while lowering costs to private business and taxpayers. And if you don’t like this model, suggest another — but don’t just sit there. Working together and learning from one another, we can fix the problems facing our country.

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