In effort to prevent hospital visits, paramedics treat patients in their homes
When 97-year-old Clara Morano had trouble breathing as well as swelling in her legs earlier this year, an ambulance took her to the emergency room at South Shore Hospital in Weymouth, where doctors helped her recover.
If those symptoms return, she may not have to leave home. Morano, who has congestive heart failure, is among the patients who could be served by a new program that is deploying paramedics to provide hospital-level care in patients’ homes.
Under a doctor’s remote supervision, South Shore paramedics will check vital signs, draw blood, and give medications to help patients manage chronic health issues. The goal is to keep patients comfortable at home and prevent the need for expensive and inconvenient emergency room visits and hospital admissions.
That’s an appealing option to Morano and her daughter, Denise Kelley, with whom she lives.
“It’s getting more and more difficult to get her out of the house, up and down stairs,” Kelley said. “I would much prefer someone come here and hopefully just avoid that visit to the ER.”
South Shore’s effort is one of a half-dozen programs that have state approval to try a new model of health care — called mobile integrated health — that expands the role of paramedics, who traditionally have tended to patients in crisis and transported them to hospitals. It’s a big shift for hospitals, which traditionally have made money when sick patients come to the hospital and spend the night. But the idea is gaining traction as newer payment contracts push doctors and hospitals to employ lower-cost strategies to provide care.
“We’re trying to move our care as much as possible outside the walls of the hospital,” said Dr. Jason Tracy, chair of emergency medicine at South Shore Hospital. “Our hope over the long term is this is an improvement in the care a patient gets, at a more cost-effective price point.” The South Shore program, which began this month, initially aims to serve about 100 patients in Weymouth with heart failure, chronic obstructive pulmonary disease, wounds, mental health conditions, and other complex issues. The patients will be able to schedule visits with their paramedics, who will stay in contact with the patients’ doctors by phone and video conference.
Until recently, Massachusetts did not allow paramedics to care for patients this way, except in certain pilot programs. But after the Department of Public Health approved regulations for mobile integrated health in 2018 — an effort delayed by a lack of funding — hospitals, ambulance companies, and other organizations applied to participate. Several new programs are being launched this year.
For now, hospitals are covering the costs of these initiatives, or are paying for them through insurance contracts that require them to manage their costs of providing care. There is typically no additional cost to patients.
This spring, Lowell General Hospital will begin sending paramedics to the homes of patients with chronic, advanced, and complex diseases. The paramedics won’t be rushing from one emergency to the next — instead, they’ll make scheduled visits to carry out doctors’ orders.
“They’ll go into the visit knowing what they’re going to be doing,” said Dr. Wendy Mitchell, medical director of the Lowell General Physician Hospital Organization.
The goal is to prevent patients from returning to the hospital soon after a discharge. If Lowell General prevents 20 admissions, the program will pay for itself, Mitchell said.
Tufts Medical Center is also developing a paramedicine program for low-income patients with complex medical conditions.
Brigham and Women’s Hospital is using paramedics to care for patients who are sick enough to be hospitalized but instead are part of a home hospital program in which they are monitored remotely and receive regular home visits. “It allows us to diversify the workforce” beyond doctors and nurses, said Dr. David Levine, medical director for the home hospital initiative. The paramedics give infusions and monitor heart rates, among other tasks — “the things you’d expect a patient to receive if they were hospitalized,” Levine said. While visiting nurses have long taken care of patients at home, advocates of paramedicine programs say they allow for more flexibility. Many patients don’t qualify for visiting nurse services, for example, because they are not considered homebound.
Paramedics, unlike most other health care workers, are used to being in patients’ homes and are trained to spot hazards, from potential fall risks to a lack of healthy foods in the kitchen. They’re also trained to respond quickly.
Cataldo Ambulance Service in Somerville began sending paramedics on home visits in a 2014 pilot program with Beth Israel Deaconess Medical Center. Working with traditional health care providers, the company has since expanded to three programs: one for hospice patients, one for patients hospitalized at home, and another for patients with urgent health care needs. Since August, Cataldo paramedics have made 1,200 house calls — and only twice needed to transport patients to the emergency room, said Cataldo vice president Daniel Hoffenberg.
Commonwealth Care Alliance, a Boston health care provider and insurer focused on low-income patients with complex medical issues, began sending paramedics on home visits in 2014 Now, with state officials’ blessing, it is expanding the program to Worcester and Springfield. Commonwealth Care Alliance patients can call a number when they feel sick. If a nurse determines they could benefit from a home visit, a paramedic shows up at their home that day or night.
In 2019, Commonwealth Care paramedics completed 1,494 home visits for patients with urgent problems such as urinary tract infections, back pain, migraines, and respiratory issues. The company said it saved an estimated $2.4 million because the patients avoided a hospital emergency department. And, 94 percent of patients said they were satisfied with the home visits, according to the company. For any home visit program, paramedics receive special training — as much as 300 additional hours — before they can take care of patients at home. Even then, they’re allowed to treat them only under the direction of physicians.
Weymouth paramedic Lisa Nasuti has spent her career helping patients in distress by taking them to the hospital, but often wishing she could do more. Now, she can. “We are used to approaching the patient in the home,” said Nasuti, who works for South Shore Hospital. “I think medicine is just catching up with our abilities at this point.”
Cataldo Ambulance has been providing ALS and BLS coverage for Chelsea since July 1983.
Cataldo Ambulance Service
Cataldo Ambulance Service, and Atlantic Ambulance Service (a division of Cataldo Ambulance Service), currently provides 911 responses for 17 municipalities, hospitals and numerous private contracts from 24 base locations throughout Massachusetts covering Greater Boston and the North Shore. They are also a leading private provider of Emergency Medical Transportation in the Commonwealth. The Atlantic Ambulance Service Division is the primary entity that responds to communities in the northern most region of the Cataldo Ambulance Service operating area.