Paramedic Practitioner

[Gordon, PA-C]

1 hour ago, thatgirlonabike said:

 

Our target was the uninsured patients which are NOT the cash cows of the ED.  It was highly successful and still continues to be today (I wish I could share data but it's not yet published).  

How are you going to do that?  If somebody calls are you going to refuse to see them if they have insurance?  

Is your rig only going to areas where homeless people are and ignoring the rich suburbs?

Also, ERs get federal funds for uninsured patients.  Let's not pretend that they are getting zero reimbursement.

 

[Guest thatgirlonabike]

@Gordon, PA-C

It's not how we are going to do it.  We did it.  We targeted patients who were uninsured and high utilizers of EMS and ED.  They were referred to us by primary care, the ED and by EMS workers.   We made contact with the pt and visited them in their homes.  We helped connect with with a medical home, assisted with transportation, and did medication management.  So much navigation of the complicated and fragmented healthcare system we have here in the US.  We had access to a prescription assistance program and did LOTS of education.   I was partnered with a LCSW as well.  

We did have some EMS patients who were Medicare/Medicaid.  They were easier to work with because so much of it was educating them on the resources they have available.  

[deltawave]

13 hours ago, thatgirlonabike said:

I was a Community Paramedic for 3 years prior to my life as a PA student.  I took a semester of primary care classes and did 170 hours of clinicals  with the Residents in Internal and Family medicine and in the specialty clinics with the internal medicine program (Cards, Endo, GI, Pulm etc).  With hours with practitioners and nurses in home health, wound care, hospice, palliative and peds.

Our program was a partnership between the hospital system and EMS system.  We were grant funded for 2 years and then the county took over our pay.  The hospital provided offices.  We obtained grants to buy vehicles that are maintain and owned on paper by the county. We worked within the Accountable Communities group at the hospital.

Our target was the uninsured patients which are NOT the cash cows of the ED.  It was highly successful and still continues to be today (I wish I could share data but it's not yet published).  

With the new ET3 that CMS has approved I see (and hope) that there will be more practitioners involved in programs like this. And the hospitals can still make money while patients are getting better treatment.

 https://naemsp.org/home/news/emergency-triage,-treat-and-transport-model-(et3)/

My dream job is to work with a Community Paramedic program as a PA seeing patients in their homes.  I don't see the need to another masters in medicine as PA seems like a natural progression for a lot of paramedics.  If you want to continue patient care there is no upward ladder in EMS.  

 

That’s great but as you said there was no upward mobility in remaining a paramedic.
 

May I ask if you received a salary increase for all of that training, education, and responsibility that is clearly above and beyond that of average paramedics? One argument against it on the paramedic side is that does not garner much more in terms of compensation, and one argument for it (as some have stated in this thread) is that it provides for cheaper alternatives to PAs.

Also, since you are one of the few who have done CP and now are a PA-S, could you elaborate on the difference in training as you see it. You have a unique perspective.

[MediMike]

On 12/4/2019 at 11:45 AM, Gordon, PA-C said:

How are you going to do that?  If somebody calls are you going to refuse to see them if they have insurance?  

Is your rig only going to areas where homeless people are and ignoring the rich suburbs?

Also, ERs get federal funds for uninsured patients.  Let's not pretend that they are getting zero reimbursement.

 

This isn't a situation where they respond to emergent dispatches.  Community paramedicine has been designed to either prevent transports via education, home visits, and social support, or divert them to appropriate resources other than the ED. So no, I doubt they are giving a big middle finger to upper middle class America, that's jist not who this program is designed for.

Although I'm willing to bet that if there was a high utilizer in that specific demographic then they would respond.

[deltawave]

Here is how they are applying PAs in Austin as Paramedic Practitioners; this was just published 10/8/2020. I had to watch to hear the guy say he was a “midlevel Physician Assistant.” If he had not I would have never known he was a PA. It is nowhere in writing on the video. 
 

Interesting that even a government run system chose PAs for the roll but dropped the “Assistant” from their official title to go with paramedic practitioner. I had to zoom in on his shirt, it says “EMS Physician Asst.”
 

 

 

Edited October 11, 2020 by deltawave

[MediMike]

4 minutes ago, deltawave said:

Here is how they are applying PAs in Austin as Paramedic Practitioners. this was just published 10/8/2020. I had to watch to hear the guy say he was a “midlevel Physician Assistant.” If he had not I would have never known he was a PA. It is nowhere in writing on the video. 
 

Interesting that even a government run system chose PAs for the roll but dropped the “Assistant” from their official title. 
 

 

 

What a fantastic utilization. Absolutely love it. Best of all words...can't say how many times I've thought of going back into the field.

[GetMeOuttaThisMess]

Austin?  You mean AUSTIN, TEXAS???  No way.  Actually it wouldn't surprise me.  I broached the idea with the Asst. Chief in my locale via email several years back when this was a hot EMS topic at "A Gathering of Eagles" at UTSW.  Crickets.  Listening to the scanner last night after 9p, I swear all the calls for Fire-Rescue in my locale were for assist elderly who had fallen, non-injured, and couldn't get back up.  Our municipality went to the advanced paramedic model as I understand it a couple years ago for such a service (f/u on frequent callers).  We also have a couple of high demand peak hour squads (Suburbans) for non-transport anticipated calls.

Edited October 11, 2020 by GetMeOuttaThisMess

[deltawave]

15 minutes ago, GetMeOuttaThisMess said:

Our municipality went to the advanced paramedic model as I understand it a couple years ago for such a service (f/u on frequent callers).  We also have a couple of high demand peak hour squads (Suburbans) for non-transport anticipated calls.

Are they utilizing PAs or CCT/Community Paramedics? 

[Cideous]

ANYTHING with the word "Practitioner" in it is better than "Assistant or Associate".

[ventana]

On 11/24/2019 at 7:24 PM, rev ronin said:

EMS services should be using PAs for follow-ups and frequent-flier diversion; EMT/PAs and Paramedic/PAs know how to function appropriately in a prehospital setting, while your average nurse does not. And yet, LaCOFD just announced using NPs in this role.

does not seem to matter

 

I see FNP in plastic surgery, ANP in the ICU, and the list goes on.....

 

if NP's want independence I think they should be solidly restricted to the field the are certified in.  

 

IE if you are an FNP then you do not EVER belong in the surgical fields.  Acute Care NP does not belong in primary care......

[camoman1234]

8 minutes ago, ventana said:

does not seem to matter

 

I see FNP in plastic surgery, ANP in the ICU, and the list goes on.....

 

if NP's want independence I think they should be solidly restricted to the field the are certified in.  

 

IE if you are an FNP then you do not EVER belong in the surgical fields.  Acute Care NP does not belong in primary care......

Agree 100%!

[FiremedicMike]

My chief just sent me that video in an email with the title "We need this"

 

[GetMeOuttaThisMess]

Are they utilizing PAs or CCT/Community Paramedics? 

Paramedics


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[narcan]

Austin has both one PA (Mr. Baker) rolling solo in a Ford Explorer as well as a community paramedic team.

[GetMeOuttaThisMess]

The system here as I understand it is/was follow up after the acute call.

[DogLovingPA]

On 10/11/2020 at 3:47 PM, ventana said:

does not seem to matter

 

I see FNP in plastic surgery, ANP in the ICU, and the list goes on.....

 

if NP's want independence I think they should be solidly restricted to the field the are certified in.  

 

IE if you are an FNP then you do not EVER belong in the surgical fields.  Acute Care NP does not belong in primary care......

Got this email from the hospital system I work for a couple days ago.  

[canfield]

I love seeing this. Too bad PA schools could care less about paramedic experience it seems.

[MediMike]

17 minutes ago, canfield said:

I love seeing this. Too bad PA schools could care less about paramedic experience it seems.

Interesting. I've found it to be the one strongest HCE for admission to my program over the years. 

[canfield]

That's good, Mike. Keep up the good work! You may become the exception, in my opinion.

[MediMike]

20 minutes ago, canfield said:

That's good, Mike. Keep up the good work! You may become the exception, in my opinion.

??? 

Graduated around 5 years ago, around 20% of my class was prior EMS, has been holding pretty true +/- the last couple cohorts that I've been back to help teach.

[canfield]

1 minute ago, MediMike said:

??? 

Graduated around 5 years ago, around 20% of my class was prior EMS, has been holding pretty true +/- the last couple cohorts that I've been back to help teach.

Sorry to hijack this thread. It is awesome to see PAs in the field alongside paramedics.
I interviewed for a fire officer position several years ago  (maybe 10?) at a smaller department in California and a major part of that process was how to handle creation of community EMS programs and how to incorporate advanced practitioners. This has been on the radar for a long time and what the Fire and EMS need going forward seems to be a formal specialty or certification for field practitioners whether PAs or NPs. This would formalize a career pathway. Also, some formal adopted EMS methodology from NREMT would be helpful if not required.

Mike, Good on your school. It would seem that many schools are lowering or dropping their HCE experience requirements and that many are saying HCE plays little role in PA training or practice. Good luck, Mike.

[canfield]

One other thing to consider is the ability for a field PA or NP to authorize a patient to be transported to an alternative destination such as a clinic or urgent care. Or, possibly direct admit. Are there field PA programs doing this? When I worked in Los Angeles County, the EMS agency formally attempted to create a policy to allow paramedics to transport to urgent cares ... but, it didn't fly. Perhaps it would now with a PA/NP?

[rev ronin]

1 hour ago, canfield said:

One other thing to consider is the ability for a field PA or NP to authorize a patient to be transported to an alternative destination such as a clinic or urgent care. Or, possibly direct admit.

I think one of the problems with this is that a destination currently needs to be defined as a hospital (whatever that means) to Medicare/Medicaid for the government to pay for the transport.  If you fixed that problem, I suspect this would be a more realistic option.

I've had an idea to have a county-wide web status board, which would list every ED, every UC, and wait times... but yeah, that might take people to lower priced options, so the EDs wouldn't go for it, and it might get more serious acuity folks into the non-busy UCs, so they probably wouldn't go for it either.  Systemic issues...

[ohiovolffemtp]

3 hours ago, MediMike said:

Interesting. I've found it to be the one strongest HCE for admission to my program over the years. 

I've not seen this (EMS experience in particular paramedic experience) being seen as a strong plus for admission to PA programs.  Even on these boards there's at least 1 PA program faculty member who isn't at all positive on paramedics as PA students.  When I went to PA school the most common demographic was a ~ 24 y/o/f current athletic trainer with some ortho experience.  On the other hand, in my experience it's the former fire service (or other 911 service) medics who are most eager to dive into the higher acuity patients in EM and are excited by the most gnarly injuries and procedures.  I think it's a mindset (and experience as a team leader) that drives this.

[GetMeOuttaThisMess]

Back in the stone age not everyone and their mother were EMTs or paramedics so I can see how it would have been an advantage to us who were.  Myself and a classmate/friend of mine were the first ACLS partaking PA's at UTMB-Galveston because we DID have an EMS background, unlike our classmates.  As I understood it, some strings had to be pulled to let us in, just like years later when I took ATLS but it was hush hush even then though I had several years of EM experience by then.