'Untapped opportunity' as Mayo Clinic expands at-home care with paramedic program

ROCHESTER — After doctors took about a half-basketball's worth of cancerous tissue from the back of her leg, Barb Virnig knew her options were limited.

The 75-year-old retired nurse couldn't dress the wounds from her October surgery by herself. The nearest short-term recovery facility with room was 40 miles away from her home — and from her doctors.

That was before she heard about Mayo Clinic's community paramedic program. Trained paramedics have visited her home at least once a week since the beginning of November to treat her wound and check her blood pressure and heart rate.

"It's more than helpful," she said. "I try to use them as much as I can."

The Mayo program has rapidly expanded since it started two years ago, going from treating patients with diabetes to working on wounds and assessing patients for cancer treatment and heart failure, among a host of ailments. The program has spread throughout the Rochester area and will likely grow even larger over the next few years.

"The more we grow and the more we do, the more the hospital wants us to grow," said Dr. Rozalina McCoy, the medical director overseeing Mayo's community paramedic program.

An endocrinologist and researcher, McCoy launched the program after learning about other community paramedic efforts in the U.S., Canada and Australia. The Minnesota Department of Health recently gave McCoy the 2022 Minnesota Rural Health Hero Award for her work bringing community paramedics to southeastern Minnesota.

Community paramedic programs are a recent spin on an old concept where doctors used to check on patients in their homes. Though the idea has been around since the '90s, programs have been slow to start up as they're not typically covered by federal reimbursement rates.

Yet, health care experts and advocates say community paramedics are key to the future of emergency medical services in Minnesota and the U.S. By giving care at home, paramedics could help prevent more serious illnesses and potentially cut down on health care costs for urban and rural patients.

"There is a significant … untapped opportunity there," said Dylan Ferguson, executive director of the Minnesota Emergency Medical Services Regulatory Board.

Minnesota was one of the earliest states to encourage community paramedics, even if only a handful of hospitals have created programs. Lawmakers in 2012 passed a bill covering community paramedic programs through Minnesota's Medicaid program, making Minnesota the first state to offer reimbursement. At least 14 states have followed suit or are reviewing similar legislation, but federal officials have made little progress in tweaking funding streams for community paramedics.

State and federal reimbursement rates are typically paid based on patients who are taken to the hospital or transferred to another hospital; insurance companies typically follow those rates when setting their own coverage.

EMS experts say federal officials are taking too long to change the rates and adapt to changing health care models, which contributes to ongoing staffing and funding needs among ambulance services.

"While Minnesota pays for it under Medicaid, it's really Medicare and the insurance companies that we need to get into the ballgame," said Gary Wingrove, a paramedic expert at Mayo Clinic who also chairs the International Roundtable on Community Paramedicine.

That lack of reimbursement has stifled programs in the past, but health systems are increasingly looking into community paramedics as a way to keep patients out of packed hospitals.

"Five to seven years ago, there probably wasn't as much of a financial benefit based on the reimbursement models that hospitals used to have," said Michael Juntunen, a coordinator with Mayo's community paramedic program. "Today, there's more patients coming in than there's beds in the state of Minnesota."

Minnesota programs are slowly growing. According to Ferguson, only about 200 out of 3,700 paramedics throughout the state have community paramedic certification, up from about 140 paramedics in 2019.

That includes the six full-time community paramedics at Mayo, who also cover emergency shifts and work at a walk-in clinic three half-days a week at the Landing MN, a homeless shelter in Rochester.

At the start of the COVID-19 pandemic, community paramedics were sent out as a sort of mobile unit to address area needs, but Mayo officials soon had the program tackling previously unknown health issues among the homeless, which became the clinic at the Landing MN. That led to paramedics addressing multiple health issues in patients throughout the region.

"We really built on the community paramedic clinic to build out this entire health care infrastructure that didn't exist anywhere in southern Minnesota before," McCoy said. "We kind of take the approach of: A problem comes, we start to tackle it and we build out all that we need around that."

Community paramedics cover about a 40-mile radius outside of Rochester, though they see patients from Albert Lea to Lanesboro and Winona.

A 2020 Mayo Clinic study found 32 patients with serious medical needs significantly cut down on hospitalizations and primary care by using community paramedic visits, but it's unclear whether the paramedic visits actually trimmed the cost to treat those patients.

Mayo is working on a large-scale study to conclusively determine whether paramedic visits at home can save money for the hospital and patients alike. At the same time, Mayo is getting more interest from paramedics who want to continue their career path in the program.

"I love the fact that we're able to talk to patients on a more human-to-human-type interaction," said Phoebe Sanft, a community paramedic who worked at a similar program in New York before switching to Mayo earlier this year. "We're able to provide them with a lot of education and knowledge that they may not have received in the hospital."

McCoy and Juntunen say the hospital system is looking to expand community paramedic programs to its ambulance services in areas such as Mankato, St. Cloud and Duluth during the next five years to help address community health issues.

For Virnig, the program means she can continue to live independently at home — and reward the paramedics at her house on Tuesday with a large plate of cookies her sister baked.

"To have somebody come into the house," she said, "I don't have to worry."