FOX19 Investigates: City looks to new model to answer 911 calls
CINCINNATI, OH (FOX19) -
With more than 17 million dollars in outstanding EMS charges in collections, FOX19 Investigates has learned Cincinnati city leaders are looking at a major change to the city's Emergency Medical Services system. They hope the change could cut down on costly non-emergency medical calls to 911.
FOX19 Investigates analyzed EMS data from the Cincinnati Fire Department. We looked at emergency calls by incident for the years 2012 and 2013. We looked at why people were calling 911 and the frequency of callers, as well as how much those services cost taxpayers.
In Cincinnati, a fire truck or engine responds to every incident. Depending on the severity of the initial call, an ambulance may be sent in addition to the truck or engine. If a caller refuses transportation to the hospital or if EMS staff determine transportation to the hospital is medically unnecessary, those EMS runs are never billed.
“In Cincinnati, we know our EMS staff make a ton of runs,” said Cincinnati City Councilmember Yvette Simpson. “It's highly expensive, it's very expensive to provide this service. We want to do it and we will do it in emergencies, but there are more cost-effective ways for individuals to be treated and get help outside of EMS.”
For the year 2012, the department's yearly budget was $94, 557, 708. Records show from 2011 through 2013 EMS collected $20.2 million.
Fire officials said from 2011 through to date there's $17.5 million dollars in outstanding EMS charges that have been forwarded to collections. A fire official told FOX19 Investigates the city assumes it will never collect that money. That's the equivalent of paying the yearly salaries of 350 firefighter/paramedics or paying for the estimated operating costs of the street car for more than four years.
In 2012, crews responded to 75,412 calls. Of that number, 55,077 were medical. There were dozens of categories, ranging from abdominal pain to heart problems to overdoses. Crews were also sent on with thousands of person "sick" calls that included toothaches, itching and even one hiccups call. There were also thousands of unspecified “sick person” calls.
The data from 2013 was very similar. Crews responded to 81,995 calls. Of that, 55,250 were medical.
Cincinnati Fire Chief Richard Braun said there are patients who do use the 911 system as a doctor. He said there are others who repeatedly call for chronic issues, patients commonly referred to as “frequent flyers.”
“They look at the fire department like we have all the answers,” Braun said, but he explained said crews have a responsibility to treat every call as an emergency. "You just never know, you have a frequent flyer and you maybe go five times and this is nothing and the sixth time you go, they're actually sick and it's life-threatening," he said.
“I called 911,” said Eloise Smelly, 95, who lives in the College Hill neighborhood of Cincinnati. “"They would come whenever I would fall. I called many a times (sic) and they were helpful."
In fact, records show during a six-month period Smelly called 911 once a month.
“She would have some falls in the middle of the night, she would have to call the EMTs to help her up,” said Lutish Martin, a family member who has since moved in with Smelly. “Every time she would have a fall or feel uncomfortable, she would call.”
Chief Braun and Councilmember Simpson say an EMS model known as community paramedicine may be a way to improve the city's EMS response. Simpson said the goal of community paramedicine is to get patients the help they need before they turn to 911. For example, in Smelly's case, might have included welfare checks or in-home visits.
“It's a great thing for Cincinnati not just as a business case, because it's less expensive, but it actually serves the community better," said Cincinnati councilmember Yvette Simpson. “I think community paramedicine provides the most effective and best care. It's a good compromise.”
Simpson said the long-term solution is not collecting more, but to cut down on the number of non-emergency calls in the first place. “We do the best that we can with the resources that we have to get that reimbursement,” said Simpson.
The city contracts with McKesson, a third-party contractor, for collections. The city pays McKesson $735,000 a year. The spokesperson for the city manager's office said EMS billing collections for 2014 were up $565,000 over estimates. A change in the EMS billing administrator by the Fire Department has helped to achieve these results. According to the city manager's office, in 2011, the city conducted an evaluation of the EMS billing system and found that collections were weak based on industry norms, the electronic patient are reporting platform was obsolete and the service model and business reporting were inadequate and outdated. Since late 2011,
“We do the best that we can with the resources that we have to get that reimbursement and where there's a gap that's why we have the dollars to be able to fund the work that our firefighters do,” Simpson said. “If we don't send someone out and it's an emergency, we haven't provided proper care.”
That “something else” could be referrals to specialized services, or in the case of seniors like Eloise, in-home visits.
“What we want to do is put these people into the system where they're getting what they need,” said Braun. “So that's what community paramedicine is all about. An ambulance won't come, more than likely it will be someone in their car like an in-home nurse to check you out that way as opposed to calling for an emergency vehicle to show up.”
"Anything they can't do, they will call 911," said Martin, as she sat in the living room of the College Hill home she now shares with Smelly. "I think it would be a good thing, rather than sending the big truck out. I'm here with her now, but there are a lot of elderly people that don't have someone."
Braun said the department has been actively researching community paramedicine as an option for the last year. The department has been looking at the model's application in cities in Minnesota and Texas.
According to the city manager's office Ohio law does not currently allow EMS providers to perform these services on a non-emergency basis. Braun said there are some administrative changes that must be approved by the state EMS board. He anticipates the change should be approved by the first of the year. Braun said the department will then decide if additional medics need to be hired or if current employees will need specialized training.
Councilmember Simpson said bringing community paramedicine to Cincinnati is a top priority.
“I've been pushing and urging, so I expect we're going to get it done very soon,” said Simpson.
According to a city memo obtained by FOX19 Investigates community paramedicine is “a new and emerging concept” that the fire department is assessing. The memo went on to read that community paramedicine is intended to be an organized system of services based on the needs of the community in which it's serving with the purpose of addressing gaps in the primary care services. Providing services such as welfare checks, medical and surgical; follow-up home visits, medication maintenance checks and other health care-related needs.