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
comprehensive electronic health records. These electronic modes of collecting patient data are helpful
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