EMS providers could transport to non-emergency facilities under Indiana bill

Emergency medical service providers primarily transport patients to emergency departments — even if that isn’t the most appropriate facility for care. That’s because it’s the only way they’re able to receive reimbursement.

An Indiana House committee approved a bill that would change that.

Senate Bill 505 would allow EMS providers to bring patients to non-emergency facilities, including urgent care and mental health facilities. It would also require providers establish protocols to determine the appropriate facility for each patient.

Tony Murray, Professional Fire Fighters Union of Indiana president, was a paramedic for 28 years. He said he would bring patients to the emergency room who just needed a mental health evaluation.

“I would come back, six, seven, eight hours later, and that patient is still there waiting for a consult,” Murray said. “Just across the parking lot, literally, is a standalone mental health or addiction facility.”

The author of the bill, Sen. Spencer Deery (R-West Lafayette), said the bill does require the EMS providers to create written agreements that include policies on where patients can go, the operating hours of those facilities and what to do if a patient refuses to be transported there.

Deery said the goal of the bill is to allow EMS providers to transport patients to these facilities, not to determine the details.

“All of this is going to need to be worked out with the people on the ground before it's actually happening,” Deery said. “What the language is simply saying is, ‘If you can figure all that out, don't let the government be the excuse for you not doing it.’”

Deery said SB 505 also gives Hoosiers more options to avoid a high hospital bill.

“The ER is some 10 times more expensive for the patient and often not always the best place for some people that are currently being transported,” Deery said.

However, some lawmakers raised concerns about whether EMTs, paramedics and other EMS providers could properly evaluate and triage patients in the field.

Murray said field training is already building those skills.

“We have many, many paramedics and EMTs now, along with law enforcement, taking the crisis intervention team training, which creates these elements to help facilitate field triage,” Murray said.

Murray said having people in the field help to evaluate and triage patients could help address overcrowding and boarding in emergency rooms.
 

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In addition, Murray said as EMS duty officers may know where resources are more than a given doctor in a specific hospital. He said EMS providers know where stroke centers, trauma centers and cath labs are — which means they can quickly evaluate what community resources might be more quickly available to the patient.

“We also know who has psychiatric services or specific addiction services. So we would make those calls to see if there are available beds,” Murray said. “First, space in the ER. And then is there a bed for admittance if we think that the patient's gonna be admitted?”

Deery said there’s already been some pilot studies to gauge if that’s possible, especially when it comes to the evaluation of a mental health crisis.

“They determined that paramedics can apply a protocol to identify patients with suspected mental illnesses who can be treated safely in mental health crisis centers. And, that doing so, enabled patients to obtain mental health services more quickly and calmer and provide some relief on the ER,” Deery said.

Advocates said the ability for EMS providers to transport to mental health facilities supports Indiana’s effort to create a statewide behavioral health crisis response system through what’s known as the Certified Community Behavioral Health Clinic model. Indiana currently has eight pilot sites providing crisis services 24/7.

READ MORE: Clinics that expand access to mental health, substance use treatment receive official certification

Sydney Moulton, with the Indiana Council of Community Mental Health Centers, said SB 505 means patients don’t have to make an additional stop at an emergency room before being transferred to one of the behavioral health crisis centers.

“The implementation of this bill will significantly help fill that gap with our Community Mental Health Center and [Certified Community Behavioral Health Clinics] to have patients get access to care more quickly,” Moulton said.

Moulton said these eight sites currently serve the entire state. She also said Indiana plans to expand the program to include 16 additional sites in the next few years.

The Indiana Council of Community Mental Health Centers said the goal is for the remaining 16 Community Mental Health Centers to transition into the Certified Community Behavioral Health Clinic model by 2027, but that requires continued fiscal support from the state.

The bill now moves to the full House.
 

Abigail is our health reporter. Contact them at aruhman@wboi.org.