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The Medicine BehindMobile Integrated Healthcare Practice
Jeff Beeson, DO, FACEP, RN, EMT-PMedical Director - MedStar
Emergency Physician’s Advisory Board
Michael R. Wilcox, M.D.Medical Director
Hennepin Technical College
Brent Myers, M.D., MPHMedical Director
Wake County EMS
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Role of the Medical Director
“These areour patients”
“This is mypractice of medicine”
“I’m calling fromDr. Beeson’s office”
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The Issue…
• 5.6 million health care jobs will be created by 2020
• Today, 40 million people > 65– 70 million in next 20 years
• 2012 - 25,000 docs short – By 2020 = 40,000 short
Association of AmericanMedical Colleges
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We have an answer for this
challenge!
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Scope vs. Role
• Recall: 37 million house calls already• Urban experience – Most “skills” are social,
not clinical• Rural experience – May be some expanded
role?– Perhaps using other inter-professionals?
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Provider Selection
• May depend on gap being filled– EMT/paramedic/RN/NP/PA/MD– Mesa, AZ
• NP and Fire-Medic on fly car• Low acuity calls triaged to them
• May depend on regulatory environment
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Provider Selection
• Technician vs. Clinician vs. Practitioner• Taking the long view• Critical thinking• Providers with the longest scene times?
Adrenaline Junkie
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EMTs & Paramedics
• EMTs/Paramedics already know how to deliver care locally
• Know how to assess resources and make decisions
• They could fill gaps in care with enhanced skills through targeted training
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Provider Training
• Core curriculum– Disease processes– Patient assessment/education– Community resources
• Role Specific– EMS Loyalty Program– CHF– Hospice– Primary care
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Provider Training• Involve LOCAL stakeholders
– Case managers– Behavioral health– Cardiologists– Hospice RNs
• Develops relationships/trust
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Provider Training• Clinical Rotations
– Community clinics– Homeless shelters– CHF clinics– CVICU’s– Behavioral health– Hospice units– MHP programs
• Actual home visits
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Healthcare System Integration• Needs determination
– Medical interface• Cardiology / Specialty
– Care plans and protocols• Home health
– Support – not replace– Focus on transition of care
• Skilled Nursing– Referrals / coordination– In-house support
• Wake county fall program
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Program Development
• Coalition building– Needs assessment– Relationships!– Gap analysis
• Filling the gap– What’s missing and how can we help?– Sought out or discovered
• Expanded scope vs. expanded role– Most valuable ‘interventions’– Know your regulatory environment
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Program Development
• Protocols– Based on gaps to be filled– Eligibility criteria for ECNS
v12.1 Code
Pri Description v12.1 CAD Code NAED Appr'd
KYMedStar Appr'd
PSIAM Code
Pri ECNS CAD Code
02A01 3 No difficulty breathing or swallowing (rash, hives or itching may be present)
02A01n-Allergies/Envenomations Y Y 02A01 O 02A01n-Allergies/Envenomations
02A01I 3No difficulty breathing or swallowing (rash, hives or itching may be present) - Injection administered or advised 02A01In-Allergies/Envenomations Y Y 02A01I O 02A01In-Allergies/Envenomations
12A01 3 Not seizing now and breathing effectively (verified) 12A01n-Convulsions/Seizures N N 12A01 3 12A01n-Convulsions/Seizures
12A01E 3Not seizing now and breathing effectively (verified) - Epileptic or Previous history of seizures 12A01En-Convulsions/Seizures N Y 12A01E 3 12A01En-Convulsions/Seizures
12A02 3 FOCAL seizure (alert) 12A02n-Convulsions/Seizures N Y 12A02 3 12A02n-Convulsions/Seizures
12A02E 3 FOCAL seizure (alert) - Epileptic or Previous history of seizures 12A02En-Convulsions/Seizures N Y 12A02E 3 12A02En-Convulsions/Seizures
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Quality Assurance• Continuing education
– Real-time MD/MHP interaction– PCP/Medical Director communication– Programmatic feedback/enhancement
• Call reviews– ECNS tape reviews– Patient care reviews– Care Coordination Councils
• Monthly CE meetings– Case reviews
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Care Coordination
• Care Coordination Council– Case Managers– Community-based social services– Meet monthly to discuss enrolled patient
needs• On-line consultation
– “Best Option” patient determination– Not a Part-Time job!
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Electronic Medical Record
Key for patient navigation
determination
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Resource Balancing
• “Mission creep”• Alignment of can do and should do
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Not for the faint of heart?