RANDOLPH — Gifford Medical Center is partnering with three White River Valley ambulance services to have first responders conduct non-emergency visits with patients who are frequently seen at the Randolph hospital’s emergency room.
The hope is that these social calls can help identify and address issues that may make it difficult for people to take their medication as prescribed or to make it to their regular appointments, Gifford Chief Medical Officer Joshua White said.
Beginning next month, Gifford will pay Chelsea-based First Branch Ambulance, South Royalton Rescue Squad and Bethel-based White River Valley Ambulance a per-visit fee to make non-emergency visits to patients the hospital has identified as having frequent emergency department visits and/or hospitalizations. Ideally, the ambulance crews’ visits will help reduce trips to the emergency room and stints in the hospital, White said.
The program, originally slated to be funded through a $10,000 grant from the state, will be “using the ambulance service as — at least to begin — as just a social outreach tool,” White said.
The new effort builds on an earlier partnership between First Branch Ambulance and the Chelsea Health Center, a Gifford Health Care clinic, in which the ambulance crew made house calls to check in on residents who wanted assistance themselves or whose family members or friends requested them.
Chase Ackerman, First Branch’s director, said those visits, which began a few years ago, switched to telephone check-ins last fall amid increasing numbers of COVID-19 cases in the region.
“Honestly, especially now with COVID and stuff ... a 15-minute conversation with somebody can make a huge difference,” Ackerman said. The “majority of people we visit don’t leave their house.”
The Gifford program will differ in that the hospital is going to provide the ambulance services with a list of people the providers would like the first responders to visit and with a list of questions they’d like them to ask.
White said he envisions the visits as 15-minute interactions in which the emergency medical technicians ask questions such as: “How are you doing? Do you understand your medications? Is there any food in your fridge?”
The medics might also observe whether or not the patient’s heat is on and if there are beer bottles scattered on the floor, and check with the patients to see if they know when their next doctor appointments are and have a way to get to them, White said.
The pilot project is one of Gifford’s efforts to move away from fee-for-service payments to a quality-based system through the accountable care organization OneCare Vermont, in which the hospital gets paid a per-patient fee for keeping people healthy, White said.
In the traditional fee-for-service model, doctors focused on addressing people’s specific ailments and if the treatment didn’t work, the patients wound up in the hospital where they or their insurance company would be charged based on the amount of care provided, White said.
In contrast, the house call program aims to sort out social issues that may be making treatment difficult, he said.
“(We’d) rather prevent problems before they get you to the hospital,” White said.
Upper Valley Ambulance ran a similar pilot project in Orford and Piermont a few years ago in conjunction with Dartmouth-Hitchcock’s Lyme health clinic. That project has since “stalled,” said Alan Beebe, Upper Valley Ambulance’s executive director. But, he said, the organization hopes to restart it soon.
“We are working to get the program up and running again and hope to venture into Vermont as well,” he said in an email.
The Gifford program will be somewhat limited in scope to start, said Matthew Parrish, White River Valley Ambulance’s director. He expects his organization will begin by visiting 13 patients who live within 10 miles of the organization’s Bethel headquarters.
While Parrish’s group hasn’t participated in a formal program like this before, it has worked with the Gifford health center in Bethel to draw blood from a patient who couldn’t make it into the clinic to have it done, he said. In another case, an ambulance crew went out to visit a woman who couldn’t go to the clinic and, working with Gifford providers, they developed a course of treatment.
“I think the program will be good,” Parrish said. But, they’ve “got to get the data to show that it’s good.”
If the Gifford program is successful both in reducing costs and improving patients’ health, Parrish said he’s hopeful it can be expanded in the future with financial backing from insurers.
“A large part of it is the financial” piece, he said.
It may take a year or so to have good data to evaluate the program, Ackerman said.
It’s “hard to say whether (it will) cut down on hospital visits,” he said. But, in the meantime, the non-emergency house calls “can’t hurt.”
Nora Doyle-Burr can be reached at ndoyleburr@vnews.com or 603-727-3213.