The cost savings for the city are substantial. Medicaid payments do not fully cover the costs incurred by the city when an ambulance takes a patient to the ER; Hart says that on average Medicaid pays $224 per ambulance transport, $140 per ER visit, and $50 per medical screening exam. Emergency costs for Memphis start at $2,000, so rerouting routine health-care visits is essential. (For the six-month pilot, doctors at Resurrection Health are donating their time, while Memphis Fire is covering the paramedic positions. An anonymous grant paid for two SUVs and equipment.)
Early on, the dispatch teams carried basic medical instruments for initial-assessment purposes, such as stethoscopes. Now the cars come with a full line of emergency supplies. The teams carry medication for pain (non-narcotic), nausea, and blood pressure, for example, and when necessary, they can serve as first responders until an ambulance arrives. “We seem to have this nasty habit of being out and about and pulling up on a heroin overdose,” Hart says. “We’ve had that happen. We’ve pulled up on seizure calls.”
On September 6, the city is expanding the program with a specialized nursing unit. When a RADAR team isn’t available to field a 911 call that dispatch grades as low priority, a nurse can take the call instead. These nurses will also follow up with prior non-emergency callers to check on their status and make sure they’ve kept their appointments.
Memphis is awaiting approval on a rule to certify paramedics in community medicine—a specialized practice, and a first for the state of Tennessee.*
While the program is bearing fruit in Memphis, there’s no reason why it couldn’t be scaled nationwide. The city uses a 911 system provided by Priority Dispatch that grades the severity of emergency calls from low (Alpha) to high (Echo)—the same system used by 70 percent of all 911 systems worldwide. For the telemedicine piece, the city uses a software program that is Health Insurance Portability and Accountability Act compliant and costs just $5,000 per year.
Memphis takes an “ultra-conservative” approach to the Alpha calls that get bounced to RADAR, Hart says: no car wrecks, for example, and no calls that involve any violence. Most of the RADAR calls that do result in ambulance rides to the ER stem from an abundance of caution when dealing with the elderly.
The next big push is to get insurance providers to reimburse the city for these alt-emergency rides. As it stands, the city has a perverse incentive to respond to emergency callers with the most expensive care: a trip to the ER. Memphis is in talks with providers to change that. The results from the pilot already represent a savings for the city in terms of the decreased strain on its emergency apparatus.
“Part of what we’re going to have to do is learn by trying,” Hart says. “The preliminary data shows that [RADAR] works, and it works very well.”
* This article originally stated that Memphis is already certifying paramedics in community medicine. We regret the error.
This post appears courtesy of CityLab.