The Regional Emergency Medical Service Authority (REMSA) www.remsa-cf.com in Reno Nevada has redesigned their 911 Emergency Medical Services (EMS) System. The redeveloped system has created new care and referral pathways for callers with low acuity medical emergencies and for hospitalized patients with chronic conditions that need post discharge support.
CMS www.cms.gov awarded a three year $10.8 million Health Care Innovation Grant Award to REMSA to fund the program which began in 2012. The program subsequently received a no-cost extension to the award which lasted until June 30, 2016 to allow for additional work on financial sustainability. Some private insurers have agreed to pay for certain components of the program such as ambulance transports to sites other than to the emergency department.
The original three year CMS grant award is titled “New Care and Referral Pathways for Nonemergent 911 Callers and At-Risk Patients to Reduce Emergency Department Visits and Readmissions, Generate Substantial Cost Savings” (IC1CMS330971-01-00)”.
REMSA is a nonprofit organization founded in 1986, and serves as the exclusive ambulance provider for Washoe County which includes Reno and Sparks plus REMSA provides emergency helicopter transports to residents in northern Nevada and parts of Northeastern California.
The Community Health Program www.remsa-cf.com/community.html is in place to reduce emergency department visits. The program operates in partnership with local government agencies, hospitals, urgent care facilities, physician offices and clinics, mental health facilities, and substance abuse treatment centers. The University of Nevada, Reno School of Community Health Sciences http://onlinemph.unr.edu provides data, statistical, and measurement support or the program.
REMSA’s efforts to reduce trips to the emergency department has three related initiatives that includes a round-the-clock nurse triage line to handle nonemergency calls, transportation alternatives for nonemergency patients, and home visits from community paramedics for at-risk patients.
Originally, the target population for the program was mainly for recently hospitalized patients with CHF. However, the program now also serves COPD patients, individuals that have suffered a heart attack or have undergone heart surgery, and “supper users” who have visited the emergency department or hospital more than 12 times in the past year.
Community Paramedics (CP) also assist a local geriatrics practice with “evaluate-and-refer” patients and if necessary may refer these patients to an on-call CP who will immediately visit the patient at home.
The program has succeeded in redirecting many nonemergency patients to call the triage line rather than 911. Since launching the triage line, roughly 2,000 calls come in per month and sometimes 2,500 calls come in during periods of heavy marketing.
Preliminary analysis from the University of Nevada, Reno, suggests that transports for low-acuity nonemergency patients to the emergency department has experienced a decrease over the past two years even with the influx of 911 calls from new Medicaid enrollees.
The program has generated savings of about $7.8 million for payers and during its third year, the program generated $1.53 in cost savings for every $1 spent. Sustaining the system requires evaluating the program’s impact on key metrics, regularly engaging key stakeholders, and continually reaching out to the payer community.
Go to https://innovations.ahrq.gov/profiles/new-care-and-referral-pathways-nonemergent-911-callers-and-risk-patients-reduce-emergency for more details on this innovative approach in Reno to reducing nonemergency visits to emergency departments.
For further questions, email Brad Lee MD, JD Medical Director REMSA at blee@remsa-cf.com or email Brenda Staffan Director for Community Health Programs at REMSA at bstaffan@remsa-cf.com.