New Orleans A fascinating story ran in the New York Times by Kirk Johnson about “community paramedics” being used in Colorado along with earlier experiments among homeless populations in San Diego, San Francisco, and Washington, D.C.  There was nothing about the program that involved rocket science, but in cutting back on emergency 911 calls costing an average of more than $1000 for each call, these programs focused on prevention; getting out there, spreading the word, and creating a system of care before the crisis.  How smart is that?  Very!

Unfortunately, despite the rave reviews one could feel the double edged knife of the coming health care regime sending contradictory messages about care for at risk populations.  On one hand these programs are being driven by an emerging Medicare rule that will bar reimbursement for any hospital readmission within 30 days of a discharge if it is established to have occurred from “a preventable repeat of the previous diagnosis.”  On the other hand existing rules only allow reimbursement if a paramedic actually gives someone a ride to the emergency facility.  The bottom line is that preventive care extends life, most importantly, and saves money, which is also very important, but all of the bean counters know that having the paramedics out there in the community is unpaid in the sense of unreimbursed.

In such a situation how many cities and counties are really going to take this very important and much needed step in preventive care?  Damned few, I’ll wager, unless this cash flow is right sized.