Medstar Reaches Out to Frequent Flyers


aCommunity Health Program Reaches Out to Frequent Flyers

Targeted interventions help Ft. Worth system reduce call volume

Like many EMS providers, Ft. Worth’s MedStar has its frequent flyers. And like more and more EMS organizations are discovering, MedStar found that helping
those callers with targeted individual interventions can be a successful strategy for reducing the strain they put on the 9-1-1 system.

Systems rarely have to identify more than a handful of chronic callers to make a difference in this way. In Ft. Worth, there were 21 who, during 2008, collectively
accounted for more than 800 transports to emergency departments. That resulted in nearly $1 million in ambulance charges–most of it uncollectable. Those
callers became the initial focus of the Community Health Program, established by MedStar in 2009.

The goal of the program is to reduce nonemergency 9-1-1 calls, help patients get more appropriate healthcare and reduce overall costs to the system. Under
the program, providers developed individual care plans for each of those 21 system overusers. With those plans, those callers now get regular home visits
from advanced practice paramedics to assist them with whatever needs the program identified.

Those needs fall into several broad categories.

“Around half of them are mental health issues and psychiatric-type complaints,” says MedStar Associate Medical Director Jeff Beeson, DO, RN, LP. “Another
percentage is folks who can’t quite figure the system out. Some have legitimate medical complaints, but their specialist is at one hospital, their other
specialist is at another hospital, and our healthcare system is so fragmented, there’s no communication between the two, so they don’t know what to do.
One doctor tells them one thing, another tells them something else. Some have been sick and were discharged from the hospital without understanding their
discharge instructions.

“Our system is broken, and we’re the only common denominator. We know we transport Mr. Smith to a different hospital every three days. The hospitals don’t
know it, because they don’t communicate. So we’re the ones who need to do something about it.”

Potential subjects are identified through internal review of call records (more than 30 calls in 90 days), employee referral, and the suggestion of program
partners. With each visit, advanced practice medics assess the patients, and make sure they’re taking their medications and following up with their primary
care providers. The most needy get visited every day; others on an as-needed basis. Some, ultimately deemed system abusers, receive transport only to assigned
medical facilities, regardless of their preference.

For many, the visits represent not only proactive medical outreach, but a sorely needed source of social interaction.

“We had one lady who was calling just because she was lonely,” says Beeson. “We hardly ever transported her. So knowing that, we started visiting her three
times a week. Now she doesn’t call us anymore. She just wants someone to sit down and talk to her for a few minutes.”

Since its inception, the Community Health Program has saved more than $1 million in EMS and emergency room costs, and reduced 9-1-1 use by its patients
by an estimated 64%. For more, see
http://www.medstar911.org/community-health-program.

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