In just one of her many appointments Tuesday, Angie Hadlock, a Manatee County Community Paramedic, waited outside her patient’s apartment in her county vehicle.
A note on the front door read “walking dog,” which she explained must mean her patient, Cathy Donovan, was feeling well.
A few minutes pass and a woman with short gray hair rounds the corner. At 65 years old, she stands at just about four feet tall, pushing a small cart and holding a leash with a small brown dog at the end.
Hadlock greets the woman and the dog, Daisy, and follows the pair into the small one-room apartment. Donovan sits on the bed while Hadlock gets comfortable with her computer on the floor. Hadlock asks about how Donovan is feeling, checks her breathing, blood pressure, oxygen levels and they check on prescriptions, calling in refills where needed. It’s all part of what appears to be a routine visit for the community. But it means so much to those she treats, like Donovan.
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“She’s wonderful, she got so much done,” Donovan said. They’ve only been working together about two months, but already Donovan said she’s feeling and breathing better and they’re working with Centerstone to find better housing. Hadlock’s even secured food for Donovan at times.
In its first 90 days, the Community Paramedicine program has diverted and estimated $45,274.20 in health care costs.
Hadlock said she is not surprised at the amount of diverted costs because of the “astronomical” costs of health care. The dollar amount comes from the average cost of ambulance rides, about $969 according to Chief of Community Paramedicine James Crutchfield. The cost was considered diverted if the patient chose not to ride in the ambulance and instead sought care from a doctor or urgent care facility.
But the program is going above and beyond saving dollars. Community paramedics are also teaching clients about their medicines, offering companionship and directing them to other resources in the community. They even help clients like Donovan secure bus passes needed for transportation.
Crutchfield said he believes the program is already showing its value by reducing the burden on taxpayers.
“A lot of things can be prevented and people can be educated to more appropriate resources,” Hadlock said.
Community Paramedics — a staff of two paramedics plus Crutchfield, who occasionally sees patients — have scheduled appointments on a daily basis in addition to running along with select calls for service. The program that began in August currently has 26 active patients, meaning these are patients they see on a regular basis. However, that number fluctuates as new patients are referred.
As of Dec. 14, the program has come into contact with 358 people with needs ranging from mental health or substance abuse to frequent falls. By far, the most patient contacts have been with “high system utilizers,” or those who visit the emergency room or call 911 frequently. Clients can be referred to community paramedics or identified through call runs. But they are still saving costs because Community Paramedics aim to reduce, if not eliminate, the frequency with which their patients use those avenues.
Some patients have been seen by community paramedics more than 30 times so far, and it’s a mixture of those who can’t physically get to the doctor and those who need medical education.
“EMS here transports very few emergencies,” Crutchfield said. “Many calls can be handled by a primary care doctor.” However, their patients don’t always have access to their doctor or don’t think they should wait.
“It’s a system we created, instant gratification,” Crutchfield said, adding that when people try to schedule appointments with their doctor, if they’re put on hold, they often hear a recording telling them if it is an emergency to call 911. So often, they do.
Crutchfield sees the unit as a line of prevention in the health care system.
“The fire department has done a great job of preventing fires … in medicine, we don’t do that,” Crutchfield said.
The program received two new vehicles, paid for by grant funding, that Crutchfield said have everything an ambulance does, minus the stretcher. The SUVs even have scales and i-Stat — which can test for select lab values — which most ambulances do not, Crutchfield said.
The grant, worth $351,000, pays for the cost of the two vehicles along with the salaries of both community paramedics and Crutchfield.
Hadlock said she appreciates being able to coordinate with several care providers to give patients the care they need and help them stay out of the hospital and improve their health.
One patient, Crutchfield recalled, has next to nothing and lives in what he would consider deplorable conditions. When he asked the patient who takes care of her, she replied, “Well Angie does.” He called it a “tear-jerker” moment.
Those who have graduated from the program have not utilized the 911 system or been to the hospital in 30 days. So far, they’ve graduated nine patients.
But Crutchfield and Hadlock say they can’t place one type of success — amount of money saved or number of people helped — over the other. Ultimately, the number of dollars redirected increases and the number of healthy people increase.
But for the most part, Crutchfield said the community’s response has been positive and one of curiosity as to why this program wasn’t started sooner.