Plano FireRescue Holistic Community Paramedicine Program Sam Greif

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Plano Fire-Rescue Holistic Community Paramedicine Program Sam Greif Fire Chief June 13, 2019

Plano Fire-Rescue Holistic Community Paramedicine Program Sam Greif Fire Chief June 13, 2019

Plano Demographics • • • Population 286, 000 72 Square Miles Diverse Community Numerous

Plano Demographics • • • Population 286, 000 72 Square Miles Diverse Community Numerous Corporate Headquarters Five Major Hospitals Senior Living Centers

Plano Fire-Rescue Professional service with heart – integrity always.

Plano Fire-Rescue Professional service with heart – integrity always.

Department Accreditations Insurance Services Office (ISO) § Since 1998, Plano has carried a Class

Department Accreditations Insurance Services Office (ISO) § Since 1998, Plano has carried a Class 1 Public Protection Classification from the Insurance Services Office. § Plano was the first city in Texas to receive the Class 1 rating. § The ISO website shows that only 18 cities in Texas and a total of only 60 cities in the US have received this top rating. Commission on Fire Accreditation International (CFAI) § Since 2001, PFR has been an accredited agency with CFAI. We are being recommended for reaccreditation on March 13, 2018. § The CFAI website shows that only five (5) Texas cities and 187 agencies worldwide have achieved Accredited Agency status. Commission on Accreditation of Ambulance Services (CAAS) § Since 1998, PFR has had Accredited Agency status with the Commission on Accreditation of Ambulance Services (CAAS). § The CAAS website shows that only six (6) Texas agencies and 162 organizations worldwide have achieved this accreditation.

 Fire Station Locations PFR personnel respond to calls for service from 13 fire

Fire Station Locations PFR personnel respond to calls for service from 13 fire stations, placed strategically throughout the city. Each station is staffed with both the personnel and equipment to offer the most efficient and effective response possible. 388 Uniform Personnel 13 Engine Companies 5 Truck Companies 2 Battalion Chiefs 8 Ambulances 1 Rescue Squad 1 Utility Vehicle Various Staff and Specialty Vehicles

 Department Budget In FY 2018 -19, PFR’s Operating Budget totals $62, 061, 817.

Department Budget In FY 2018 -19, PFR’s Operating Budget totals $62, 061, 817. Budgeted expenditures are allocated as follows: Operations and Maintenance 11. 08% Capital Expenditures 3% Salary & Benefits Capital Expenditures Operations & Maintenance Salary & Benefits 85. 64%

Increasing Call Volume

Increasing Call Volume

EMS Incidents 9

EMS Incidents 9

PFR Patient Risk Assessment • Fastest Growing Disposition – Low priority emergency medical calls

PFR Patient Risk Assessment • Fastest Growing Disposition – Low priority emergency medical calls requiring an evaluation and/or non-emergent transport – Improper use of 911 services (55%)

Community Risk Assessment Patient Identification • Plano Citizen At Risk – 47% Medicare, Medicaid,

Community Risk Assessment Patient Identification • Plano Citizen At Risk – 47% Medicare, Medicaid, Uninsured – Percentage of Plano residents 65 and over projected to increase from 8. 9% in 2010 to 15. 9% in 2025. – Patients age 65 and over accounted for 44% of PFR ambulance transports in 2018. – A significant increase is projected for Plano residents 55 to 64 climbing from 11. 6% in 2010 to 15. 4% by 2025.

Readmission Pilot • Readmission Pilot Program – 40 patients enrolled; some referred by local

Readmission Pilot • Readmission Pilot Program – 40 patients enrolled; some referred by local hospitals, other from Plano Fire-Rescue personnel – Many on Plano Fire-Rescue HUG list – CHF patients = Most costly disease process in Plano and the US • One in four are readmitted within 30 days in Plano. – Reduce emergent/911 calls and hospital admission

PFR Patient Risk Assessment • High-Utilizer Group (HUG) – 1, 161 – 911 calls

PFR Patient Risk Assessment • High-Utilizer Group (HUG) – 1, 161 – 911 calls by 198 identified patients totaling 784. 6 hours of out of service time – Billable $1. 4 million and Recoup $207, 279 – Financial and apparatus out of service time benefit – Healthcare industry benefit within our community by reducing resources being used and reduction in lost cost recovery

Pilot Parameters • Pilot Program started on 10/31/2014 and ran through 1/1/2016. • Active

Pilot Parameters • Pilot Program started on 10/31/2014 and ran through 1/1/2016. • Active patient cap set at 20 patients. • Use of one employee to perform the duties of both Community Paramedic and Coordinator utilizing existing manpower. • Oversight provided by Medical Director and Deputy Chief of Community Health Services. • Timeline of programs: – Readmission Program, Fall 2014 – High Utilizer Group, Winter 2015

Selection and Training Selection Training • Paramedic in good standing • Volunteer with recommendation

Selection and Training Selection Training • Paramedic in good standing • Volunteer with recommendation of supervisor • Interviewed by Medical Director, Division Chief, and Program Coordinator • Commitment to availability and additional training • On-the-job • Physician-led training with partner hospitals specific to specialty • Clinic and Physician Office Rotations • Community Health Course • EMS conference specific tracks • International Board of Specialty Certification Course/Certification

Community Paramedic Equipment • Two dedicated vehicles – One funded by hospital • Point

Community Paramedic Equipment • Two dedicated vehicles – One funded by hospital • Point of Care Ultrasound – Funded by hospital • 2 Istats – Mobile Lab – Funded by grant from regional trauma council • Clotting Time Mobile Lab – Funded by hospital

Department Outreach • • Collin County Homeless Coalition Collin County Social Workers Association Continuum

Department Outreach • • Collin County Homeless Coalition Collin County Social Workers Association Continuum of Care Network Member of multiple hospital committees as an EMS advisor for quality improvement at local hospitals • County Mental Health Authority • Collin County Charitable Clinic Coalition

Collaborative Partnerships • Collin County Probate Court • City Departments – Animal Services •

Collaborative Partnerships • Collin County Probate Court • City Departments – Animal Services • Wellness Center for Older – Police Adults – Code Enforcement • Multiple Mental Health Facilities – Health Department • Encompass Rehabilitation – Senior Center • Baylor Scott & White Heart – Public Safety Communications Failure Clinic – Emergency Management • Medical City Plano Heart Failure Clinic • Numerous Non-Governmental Organizations

Pilot Readmission Patients • Pilot Patient Example – 77 year old referred by local

Pilot Readmission Patients • Pilot Patient Example – 77 year old referred by local hospital – Multiple 911 calls and transports Multiple hospital admissions – CPP activities: • Corrected medication errors • Established private care physician • Referred to “Matter of Balance, ” which is a different hospital partnership • Referred to a heart failure clinic • Discovered scam and referred to Plano PD • Patient education • Referral to Meals on Wheels – PT has improved mobility, independence, and no 911 calls or readmissions due to heart failure.

Pilot HUG Patient – Pilot Patient Example • 51 Transports in 2014 • Cost

Pilot HUG Patient – Pilot Patient Example • 51 Transports in 2014 • Cost $43, 350 during 10 months and 35 hours of one unit out of service time prior to enrollment • To date $0. 00 recovered payments • 2 Transports since enrollment with just 2 hours of out of service time in last 3 years

HUG Load/Length of Stay Daily HUG Census • Average length in program = 14

HUG Load/Length of Stay Daily HUG Census • Average length in program = 14 days • Not all referrals require enrollment into program • Top 5 Reasons – – – Health Literacy Loneliness Mobility Issues Mental Health Addiction

2019 HUG Patient Details • Called 911 over 50 times in 3 months. •

2019 HUG Patient Details • Called 911 over 50 times in 3 months. • Lost total mobility and has severe anger issues. • Very uncooperative to all in healthcare system. • Filed on for eviction. • Left treatment against medical advice five times during HUG enrollment. Program Intervention • Went to court to help with eviction three times. • Direct admit into physical therapy. • Direct admit into skilled nursing facility. • Patient ended up leaving and homeless. • Mental Health Warrant. • 0 -911 calls in last 90 days. • Obtained guardianship through probate court.

Community Paramedicine Program Results • Readmission Avoidance Rate – 81. 3% with a savings

Community Paramedicine Program Results • Readmission Avoidance Rate – 81. 3% with a savings for all patients of $715, 632 • Patient Quality of Life – Improved 73. 9% (self-reported) • Ambulance Transport Reduction – 66. 7% for the target patient population

Apparatus Utilization Impact • Reduced 688 calls from program participants in 2018. • Reduction

Apparatus Utilization Impact • Reduced 688 calls from program participants in 2018. • Reduction of 1, 973 hours of apparatus utilization in 2018. – This does not include incidents that required multiple apparatus. • Largest group impacted by call reduction in 2018 was the High Utilizer Group. • High Utilizer Group continuously replenished – One patient reduced another takes their place. – High Utilizer population remains constant with the top ten accounting for 94 calls monthly. – Top ten facilities that called in past 12 months account for 1, 342 911 calls.

Financial – Current program based on 1 full-time Community Health Liaison and 6 part-time

Financial – Current program based on 1 full-time Community Health Liaison and 6 part-time Community paramedics. – Current program cost to COP = $130, 202 annually (Includes personnel cost, vehicle, equipment, and maintenance. ) – $132, 484 provided by two hospitals that fund the 6 part-time Community paramedics. One paramedic works 8 hours, M-F, on overtime using existing uniform employees on first day after shift.

M E D I C S S ZEN CITI PAT IENT Win/Win

M E D I C S S ZEN CITI PAT IENT Win/Win

Questions? For more information contact: Sam Greif samg@plano. gov 972 -941 -7654

Questions? For more information contact: Sam Greif samg@plano. gov 972 -941 -7654