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Rural Health Information Hub

Barriers to Establishing Community Paramedicine Programs in Rural Areas

Rural emergency medical services (EMS) and community health programs may experience some challenges when trying to establish a community paramedicine program in their jurisdiction. For more information about identifying and addressing barriers to implementation, please see Module 4: Implementation Considerations.

Funding/reimbursement. As described by the American Academy of Home Care Medicine, payers do not typically reimburse costs related to EMS, including ambulance rides, unless the patient is transported to an emergency department. Because community paramedicine programs are designed to limit the number of unnecessary transports, this means that many of their services may not be reimbursed under traditional payment models.

Many programs are currently funded through in-kind or financial support from ambulance services, hospitals, or grants. However, EMS World reports that payers are beginning to recognize the savings that community paramedicine programs can provide. For example, Accountable Care Organizations (ACOs), which are coordinated healthcare teams that incentivize providing comprehensive care for Medicare patients through value-based payment models, are now promoting community paramedicine programs. Some private insurers are also starting to consider providing reimbursement for EMS care services, even when the patient is not transported during the encounter.

Electronic health records. Rural or resource-limited communities are less likely than urban health systems to maintain comprehensive electronic health records. These electronic modes of collecting patient data are helpful for communicating patient information with additional healthcare services and providers (also called interoperability) to support a coordinated care health services model. An integrated health records system can also help agencies track outcomes for their clients. This is valuable for demonstrating program effectiveness and identifying clients who may need additional assistance.

Statutory barriers. In some states, paramedics are only allowed to respond to emergency calls and provide medical services as a first responder. Because of this and other scope of practice regulations, state and local jurisdictions may experience difficulty establishing a community paramedicine program, according to the Association of State and Territorial Health Officials. Some states, like Minnesota and Wisconsin, have passed legislation that can support the establishment of community paramedicine programs.

Concerns about duplication of services. Some roles and responsibilities filled by community paramedicine programs may overlap with the activities of existing home health/home visiting services or community health worker programs. However, each jurisdiction can consider which types of community paramedicine services would be the most important to fill the existing gaps. Community paramedicine programs are not “one size fits all.”

Resources to Learn More

Expanding the Roles of Emergency Medical Services Providers: A Legal Analysis
Provides information about the legal challenges associated with establishing a community paramedicine program, including scope of practice, authorizing regulations, liability, and reimbursement.
Author(s): Hodge, J.G., Orenstein, D.G., & Weidenaar, K.
Organization(s): Association of State and Territorial Health Officials
Date: 2014