In Fort Worth, MedStar's Community Health Program cutting costs, improving patients' well-being

By Mitch Mitchell

mitchmitchell@star-telegram.com

FORT WORTH -- The concept underpinning MedStar's frequent-911-caller program may be difficult to grasp at first.

The program is built on the idea of requiring paramedics to periodically visit chronic ambulance users.

During the two years since the program's inception, MedStar officials have discovered that house calls are cheaper than on-demand emergency room visits and better for patient health. Now program officials are considering expanding the program and looking for funding sources.

"Educating the patient before they need to call 911 is better for the patient and better for the community," said Matt Zavadsky, MedStar associate director for operations.

MedStar can't recoup charges on many emergency room transports, health officials said. It estimated a savings of more than $2.1 million in transport charges and more than $679,000 in transport costs between July 2009 and May after enrolling 94 patients in the program.

MedStar also estimated saving area emergency departments nearly $6.6 million in charges and $758,000 in costs for the same period.

These reductions are also estimated to have decreased emergency department bed usage by more than 10,600 hours. That means emergency room beds are there for people who really need them instead of being used by people who might have been better served in another setting.

The Community Health Program was started in 2008 after MedStar officials discovered that 21 patients were using a big chunk of ambulance and emergency department resources. Those patients triggered more than 800 ambulance calls and cost the system more than $962,000 in charges, most of which were never collected because the patients lacked health insurance.

Nine of the 21 were selected for the program. They experienced a 77 percent reduction in their need for services during a 30-day test.

"From two perspectives, this program is the wave of the future for MedStar," Zavadsky said. "One group of patients uses 911 as their primary source of care, and we needed to teach them how to access healthcare in a more appropriate setting. The other group is patients who have suffered congestive heart failure and are at a very high risk for going back to the hospital for a variety of reasons."

Lloyd Fisler is in that second group of patients. Sean Burton, one of the advance practice paramedics in the program, said that two years ago when he met Fisler, the patient was being visited two or three times a week. Now that Fisler has graduated from the program, he can call a nonemergency number that will either put a paramedic at his door within an hour or send an ambulance to check on his well-being, Burton said.

Fisler said he was told about the program when he was being discharged from Plaza Medical Center in Fort Worth in 2009.

"The hospital told me that they had this service that will come and check you out, and I said 'I'll go for that,'" he said. "We started out with three visits a week, then two, then it went to one and a phone call."

Burton said that when congestive-heart-failure patients are being discharged, they often do not hear or understand the discharge instructions and often end up returning to the hospital.

MedStar is now considering accepting into the program patients with asthma, diabetes and other chronic diseases.

"We are able to explain to them in their kitchen, in a setting that is familiar to them, the things they should be doing," Burton said. "We can check that they are being compliant with diet and medications and do a full assessment. If they appear to be getting worse we can refer them to a doctor before they need an emergency room admission."

Mitch Mitchell, 817-390-7752

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