A Retrospective Review: Impact of Mesa Fire and Medical Departments Advanced Practice Prehospital Program on ED Overcrowding and Healthcare Fiscal Bearing

Abstract

Background: As the cost of healthcare in the United States (US) continues to increase, it becomes imperative to find solutions that permit safe, quality care with a lower financial investment. Utilization of the emergency department for non-emergent care is considered to be one of the costliest, and most preventable methods of healthcare. Advanced practice (AP), pre-hospital programs provide a solution to decreasing the cost of healthcare without sacrificing quality or safety. Purpose: This doctor of nursing project provides a summative evaluation of an advanced practice, pre-hospital program in Mesa, Arizona. In 2014, Mesa Fire and Medical Department (MFMD) received a grant for $12.5 million to design and implement an advanced practice program to divert non-emergent patients away from the local emergency departments while cutting the cost of healthcare. This program utilizes nurse practitioners and physician assistants to respond to non-emergent calls made within the 911 system. Results: A total of 1079 charts were selected for evaluation between October 1, 2015 to March 31, 2016. Of the 1079 charts evaluated, 694 patients (64.3%) were successfully diverted away from local emergency departments. A cost comparison between pre-hospital and hospital care was completed using evaluation and management (E/M) codes provided by MFMD. Relative value units (RVUs) were obtained for each level of care and used for estimation of emergency provider care. Based on these estimates, the costs savings provided by the MFMD advanced practice program was determined to be $718,865.09 for the six-month analysis period. Conclusions: Advanced practice providers in a pre-hospital setting are a cost-effective method of providing safe, high quality care at a significantly lower cost than hospital care.