Minnesota could have within several years several hundred practicing "community paramedics," a new designation of health care providers spawned by the shortage of doctors and nurses in rural parts of the state.
Once certified, community paramedics can deal with a range of non-emergency health care needs that otherwise, for example, might send people unnecessarily to the emergency room and wind up costing more.
Minnesota is the first state in the country to establish the new classification under law. Some officials hope that as many as 20 percent of the state's 2,200 paramedics will obtain the certification.
The concept first developed in Canada, Australia and New Zealand, where paramedics help treat non-emergency cases to prevent health issues from becoming serious.
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Services include visiting a home to check on someone who's had surgery or perhaps checking on a patient at home who's dealing with a chronic condition like diabetes, heart disease or respiratory illness.
In Minnesota, a few paramedics have been trained so far, and another six-month class of 24 began last week, taught by an instructor in a classroom at Hennepin Technical College. About half the students are in the Twin Cities and the rest participate remotely from towns in rural Minnesota. There are even a few out-of-state students participating from Idaho and North Dakota.
One of those in Park Rapids is 14-year veteran Brent Haynes, who will work with county public health officials to identify gaps in the health care system where a community paramedic might help.
Haynes, who works for North Memorial Ambulance Service, said he envisions working frequently with patients in their homes, doing basic health assessments, collecting lab specimens and performing minor medical procedures.
"We'll work in conjunction with the doctors from the ER or clinic," Haynes said. "They will assign us ... If we find there is something lacking in the environment or their capability to deal with themselves, we'll look for a solution."
Proponents of community paramedics say that treatment can reduce the need for patients to visit the clinic or make costly trips to the emergency room.
Patients frequently call 911 for things that aren't emergencies, said Christy Johnson, another Park Rapids paramedic taking the class.
"They're using the ER as their primary care physician," said Johnson, who's been a paramedic for eight years. "Hopefully we'll be able to pull those people out of the emergency care system and get them back into the primary care system."
When lawmakers approved the community paramedic certification plan last year, there were objections from the Minnesota Nurses Association. Nurses worried that community paramedics would duplicate the role of public health nurses.
This year, lawmakers refined the law, and nurse association spokeswoman Carrie Mortrud said nurses now cautiously accept the community paramedic concept.
"We still have some concerns, but a lot of the language that was added this last year said that it can't be duplicative and that the community paramedic needs to be looped in with the public health providers in the area, and we're just going to have to trust that a lot of monitoring will go on," Mortrud said.
Rural emergency medical service providers have struggled financially because between runs paramedics often have a lot of down time. Supporters say community paramedics will open new revenue streams to make those companies more viable.
The state Department of Human Services has identified which specific procedures are reimbursable under government-funded programs like Medical Assistance or MinnesotaCare. Reimbursement rules are also being established for Medicare, Medicaid and other insurance programs.
The Minnesota Department of Health provides grants to help both urban and rural counties train and integrate community paramedics into their regional health systems.
Mark Schoenbaum, director of the Health Department's office of rural health and primary care, said the models for how community paramedics will be deployed will take time to develop. But he predicted they will be an important part of the health care system in the future.
"Minnesota is facing a health workforce shortage, so we need all hands on deck, and community paramedics have a definite place in that solution," Schoenbaum said.