The Mehlville Fire Protection District, situated in St. Louis, Missouri, stands out among other districts as both a fire and ambulance service. Covering more than 50 square miles in south St. Louis County and safeguarding the lives and property of more than 134,000 residents, Mehlville Fire Protection District (MFPD) manages the demanding responsibilities of everyday fire and EMS divisions.
Despite the expansive area it covers, MFPD is far from stretched thin. In fact, MFPD continually strives to stay at the forefront of innovation by consistently adding cutting-edge treatments and practices to its progressive catalog of practices and protocols.
Most recently, committed to addressing the diverse needs of our community comprehensively, MFPD added the Mehlville Mobile Healthcare Division. This innovative addition signifies our district’s unwavering dedication to enhancing the wellbeing of our community by bringing accessible and advanced healthcare services directly to residents in need.
Founded in 2018, Mehlville Mobile Healthcare is a collaborative effort among fire district leadership, board members, medical directors, and community leaders and resources. The program was developed with the understanding that health is a multifaceted interconnection of various factors that include access to medical care, mental health support and social services. The overarching mission of the program is to improve the overall health and quality of life for the community.
Mehlville Mobile Healthcare has dedicated community paramedics who conduct home visits in an effort to assist patients in managing their healthcare needs and prolonging their independence at home. While the program strives to reduce unnecessary 911 calls, enrollment is open to any resident within the fire district at no cost.
The program involves collaboration between community paramedics, the patients’ primary care physicians (PCPs) and MFPD’s Medical Director, Dr. Melissa Kroll. Together, they develop personalized care plans tailored to each patient’s unique needs. While working towards improving the patient’s overall health, community paramedics also serve as a vital link to valuable community resources, offering comprehensive support.
Navigating innovation: Mehlville Fire Protection District’s role in ET3
Mehlville Mobile Healthcare goes beyond the scope of reducing 911 calls through home visits. The program also spearheaded the department’s involvement in the Emergency Triage, Treat and Transport (ET3) program.
So, what exactly was ET3?
ET3, initiated by the Centers for Medicare and Medicaid Services (CMS), aimed to reduce unnecessary emergency department transports for Medicare Fee-For-Service beneficiaries. This voluntary payment model allowed EMS services to triage 911 patients for potential transport to alternative destinations like urgent cares, physician offices, mental health services or specialty clinics. Additionally, 911 crews had the flexibility to provide on-site treatment guided by a telehealth provider during the pilot phase.
Despite facing numerous challenges, with skeptics suggesting its inevitable failure from the outset, Mehlville was among the few agencies that found more success than failure in the ET3 pilot.
Read more: Why was ET3 canceled and what’s next for EMS?
Decoding Mehlville’s success in the ET3 pilot
Mehlville’s success in the ET3 pilot program was no stroke of luck; it was the result of deliberate efforts and strategic planning. The first step was securing buy-in from all levels – leadership, medical direction, front-line responders, patients and the community. While obtaining support from leadership and medical direction proved relatively straightforward, the real challenge was gathering a collective commitment.
“By connecting patients with appropriate available resources and working closely with other healthcare providers, Mehlville Mobile Healthcare strives not only to enhance individual wellbeing but also to contribute to the overall health and resilience of the community we serve,” writes Rieker.
Photo/Jennifer Rieker, Mehlville Fire Protection District
Under the guidance of Mehlville’s medical direction through Washington University, Co-Medical Directors Dr. Jeff Siegler and Dr. Melissa Kroll played a pivotal role. They created specific ET3 protocols and conducted comprehensive education sessions for the entire department well in advance of implementation.
Within the Mehlville Mobile Healthcare team, a dedicated point person took charge of daily activities, overseeing data collection and providing continuous education to EMS crews. This educational focus aimed at improving patient engagement and acceptance, a crucial aspect of the program’s success. The team actively sought feedback through patient satisfaction surveys for all those offered ET3 options.
Early on, Mehlville’s recognized that provider confidence posed a challenge. While EMS providers often embody confidence, the introduction of an innovative approach to 911 calls revealed the difficulty of deviating from the traditional practice of automatically transporting patients to the emergency department.
To reinforce confidence among providers, Mehlville conducted 100% QI on all ET3 ePCRs and on every patient eligible for ET3. This approach not only ensured the program’s smooth operation, but also fostered a culture of continuous improvement and provider confidence.
MHPD gleaned invaluable insights, with the following highlights standing out:
- Safety first. Zero negative outcomes for patients who opted for the ET3 option.
- High patient satisfaction. Satisfaction levels soared, with over 95% of surveyed patients expressing being “highly satisfied” with the care they received through the ET3 program.
- Efficiency in time management. Contrary to expectations, the average call time, from initial call to back-in-service, only extended by a few minutes. By the second year, this time was even less than transport to the emergency department.
- Positive reception from payors. Notably, Medicare Advantage plans began allowing their beneficiaries to participate in ET3, and various commercial payors expressed interest in the initiative.
- Validation of EMS providers. The success of ET3 underscores the well-trained and capable nature of EMS providers, showcasing their proficiency in triaging and effectively treating patients.
By connecting patients with appropriate available resources and working closely with other healthcare providers, Mehlville Mobile Healthcare strives not only to enhance individual wellbeing but also to contribute to the overall health and resilience of the community we serve.
