911 calls will do more under health law changes

October 4, 2013

WBEZ/Michael Puente
Prompt paramedics Wayne Van Beveren (standing with red shirt) and EMT Chris Spizak (red shirt, crouching) arrive on the scene to treat a high school student. Paramedics will soon use new technology such as Skype to better assess a patients condition with a doctor.

Northwest Indiana-based paramedics Wayne van Beveren and EMT Chris Spizak arrived to Munster High School to treat a freshman who suffered a seizure.

Once on scene, they were greeted by the school’s principal, nurse and the boy’s grandmother.

They took the teen’s necessary vitals, and within a few minutes, the teen began to feel better.

Soon, however, doctors will be joining paramedics in treating patients at the scene. It’ll happen through video streaming, similar to Facetime or Skype.

“If we could have Facetime that kid’s doctor, it would have been beautiful,” Spizak, 22, of Merrillville, Indiana, says.

Spizak says such technology would save time when diagnosing a patient.
 
Van Beveren, of Manhattan, Ill., says voice descriptions can be limiting.

“There are definite occasions where I thought it would be nice if I could just show the doctor. Every once in a while you get a doctor that either doesn’t understand or just doesn’t see what you’re seeing,” Van Beveren says.

But the use of video streaming is also being considered to provide better assessment of patients.
That face-to-face contact is coming to some areas of the country including Northwest Indiana.

That’s because the way healthcare is delivered is changing due to the Affordable Care Act.

“I have been in the ambulance industry for over 30 years, and I have never seen anything that has the potential of changing it as dramatically as the Affordable Care Act will,” says Gary Miller, owner of Prompt Ambulance Service.

Based in Highland, Indiana, Prompt is Northwest Indiana’s largest private ambulance service.

The company operates its own 9-1-1 center, handling emergency calls for several cities in Northwest Indiana including East Chicago and Merrillville. He says as soon as next year, video streaming will be available on his ambulances.

“If the doctor wants to see something specific with the patient, then not only would they be getting oral reports, but they’ll also get visual reports,” says Miller.

It’ll help doctors see injuries and conditions, but there’s another reason to make the change.

“They punish hospitals for readmissions,” Miller says.

Under the Affordable Care Act, hospitals risk being fined for readmitting patients within 30 days of their last visit.

Medicare spends more than $17 billion a year on patients whose returned trips to the hospitals may have been avoided.

But efforts to avoid this are starting to take hold.

The Centers for Medicare and Medicaid Services says there were 70,000 fewer readmissions last year.

And, under the ACA, there’s a huge push to treat patients faster and smarter...and at home.

“The type of service that we are providing -- and the folks in Indiana and others are providing -- is actually safer for the patient,” says Matt Zavadsky, spokesman for MedStar Mobile Healthcare in Fort Worth, Texas. “We are not denying them access to care, we're navigating them to the right care.”

MedStar Mobile Healthcare is a leader in a movement called Community Paramedicine.

The goal is to get home treatment from medical professionals like paramedics and EMTs who are trained to treat everything from congestive heart failure to diabetes.

“We’ve got all these paramedics and EMTs out there that can do the house call and link the doctor who might be in office managing 15 other patients and the doctor instructing of how to handle the patient so you don’t have to go the hospital,” Zavadsky says.

But could redirecting people from hospitals be a liability for ambulance services like Prompt?

Owner Gary Miller says there are safeguards that follow care for patients with serious illnesses like diabetes or those experiencing chronic seizures -- at their home.

Still, not everyone is sold on the idea of video-streaming.

“I think of what we have to look at is what is the purpose of the video,” asks Dr. Howard Mell, a spokesman for the American College of Emergency Physicians.
He says video could actually slow things down, but he does see another benefit.

“The paramedic can call me and tell me ‘Mrs. Smith’s legs are starting to swell,’ there’s not much we’re going to add to that over Skype,” says Dr. Mell, who works for a hospital in Cleveland, OH. “But if Mrs. Smith doesn’t believe the paramedic that she needs to take her blood pressure medicine, it may be beneficial for Mrs. Smith to visually see me so I can tell her she needs to take her blood pressure medicine.”

“The community paramedicine concept allows the paramedic to come in and assist in those folks who may need some help but who don’t quality for home nursing therapy,” Dr. Mell said.

Overall, Dr. Mell says treating patients at often times, can be done better because it provides comfort and reassurance.

All the patients need, he says, is more instruction or assistance to properly care for themselves.

Follow WBEZ NWI bureau reporter Michael Puente on Twitter @MikePuenteNews and on Facebook.

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