Community Paramedicine: 911 Alternative Destinations Are a Patient Safety Issue

The 2010 Patient Protection and Affordable Care Act (ACA) served as a conduit for many previously uninsured U.S. citizens to obtain health insurance; however, insurance does not necessarily equate to timely access to care. A 2015 study found that efforts by policymakers and health insurance plans to drive Medicaid patients out of emergency departments (ED) and into primary care clinics are not working. 1 More than half of all providers listed by Medicaid managed care plans could not offer timely appointments to enrollees, despite a provision in the ACA temporarily boosting pay to primary care physicians treating Medicaid patients. The median wait time was two weeks, but over onequarter of providers had wait times greater than one month. Consequently, newly insured patients are increasingly seeking care in EDs and the reliance on emergency care remains stronger than ever. In a May 2015 poll, three-quarters of emergency physicians reported that emergency visits were going up. This represents a significant increase from just one year ago when less than half reported increases.2 Lastly, a recent analysis of health plans under the ACA revealed that one in five plans did not even list any emergency services on the list of covered benefits.3 This results in increased financial burden to patients when emergency care is provided by an “out-of-network” emergency physician, frequently leading to the patient receiving a “surprise” balance bill. Increased demand for emergency services leads to longer wait times, crowding and increased patient boarding in the ED. All have been associated with several negative patientoriented outcomes – from lower patient satisfaction scores to higher inpatient mortality rates.4 Recognizing this, multiple stakeholders are currently working to mitigate the ballooning crowding dilemma. One approach gaining popularity is community paramedicine (CP). CP is a “model of community based health University of California, Davis, Department of Emergency Medicine, Sacramento, California The Permanente Medical Group, South Sacramento Kaiser, Department of Emergency Medicine, Sacramento, California California American College of Emergency Physicians Board of Directors *