Texas Community Paramedicine Program`s Revenue Lower Than Expected

DALLAS — Dallas paramedics are making plenty of house calls, but they’re not making much money for the city.

Officials started the Mobile Community Healthcare program last year with the hope that that it could pay for itself using fees from hospitals that want to alleviate the burden on their emergency rooms. But records obtained by The Dallas Morning News show that the program is off to a slow start.

The city invoiced $56,325 through the first six months of the program. More than $41,000 of the fees had yet to be paid.

That means the program is on track to pay for only about two of the seven paramedics on staff this fiscal year.

“In terms of revenue, I had hoped to be further along than this,” said Assistant Chief Norman Seals. “But I think we’re on a good track right now, and really starting to show some good positive improvements.”

Still, Seals and other officials remain optimistic that it’s simply a growing pain of a program that will grow to be something special for people who need help.

“In my book, it will always be about the patients we’re working with,” he said.

The fledgling Dallas program is based on two tiers. The first is to teach so-called EMS frequent fliers, who use 911 as their primary health care provider, to care for themselves. The second is to keep patients out of the ER.

Hospitals have some financial incentive to take part in the program: The Affordable Care Act created Medicare-reimbursement penalties for hospitals that see heart patients readmitted within 30 days.

Dallas Fire-Rescue, which is mainly a medical emergency service, is in a position to fill that gap. Hospitals could pay Dallas Fire-Rescue to visit their patients and still save money by avoiding the penalties.

And the program allows Dallas Fire-Rescue to keep expensive ambulance runs down in a city where 911 medical calls have ballooned in recent years. Instead, the paramedics visit patients in a Ford Escape SUV.

But for now, only two hospitals have deals with the city: UT Southwestern Medical Center and Children’s Medical Center Dallas.

Seals said he has some other big deals in the works that will make the program self-sufficient. Dallas Fire-Rescue Emergency Medical Director Marshal Isaacs, a UT Southwestern professor, said a pilot program with Parkland Memorial Hospital is planned.

Other deals could be on the way, too.

“It’s safe to say that every major health care hospital system in Dallas is interested in this topic and this program,” Isaacs said.

But the contracts take months to hammer out, mainly because of legal issues.

Isaacs said the program has made enormous reductions in 911 calls by the so-called frequent fliers, saving ambulances hundreds of trips. Those who have taken part in the program have cut down their 911 calls by more than 80 percent, Seals said.

Seals has won plaudits in the fire service industry for his leadership of the program. City Manager A.C. Gonzalez has been supportive. And the program has turned Seals into a serious contender to be the next Dallas fire chief.

A similar MedStar program in Fort Worth helped provide a blueprint for Seals, but Dallas became the largest city yet to start such a program.

Plano Fire-Rescue has a similar program. Chief Sam Greif said everything he has seen shows the program is successful. But his department doesn’t have any official contracts with hospitals yet.

Seals and Isaacs have big ideas for expanding the program. They believe the program can eventually help people who are homeless, have substance abuse issues or suffer from mental illness.

Seals believes the program will become big in Dallas, even if the money isn’t there yet.

“It’s a great program doing a lot of great work,” Seals said.

©2016 The Dallas Morning News