With continuously rising medical costs, an aging population, and a shortage of doctors and nurses, a more rational use of health care providers’ time is very much needed.

Fortunately, the Trump Administration has been working on a policy to help with this issue.

Starting next year, Medicare is planning to pay paramedics to provide a broader range of care; now state and local government leaders need to take action so that their constituents might benefit from the new payment model.

Specifically, states will need to pass laws and write regulations that allow paramedics to deliver more services if they have not already done so, and localities that deliver emergency medical services (EMS) should prepare to set up or expand community paramedicine programs.

What are the new services that Medicare will begin covering? The new payment model will pay for paramedics from participating ambulance service suppliers to do the following:

  • Treat patients at their homes rather than transporting them to a medical facility,
  • Provide telehealth by connecting patients with doctors via video link, and
  • Transport patients to a doctor’s office or to an urgent care center. (Patients will be able to decline an alternative destination and instead be taken to the emergency room if they prefer.)

These services are part of what is called community paramedicine. The specific services listed above are included in the government’s request for applications, but it might be possible to have other services covered by Medicare by requesting a waiver.

To better serve patients, states should pass laws and create regulations, if necessary, to expand the role of paramedics, including giving them the authority to transport patients to places other than emergency rooms.

As of 2017, only seven states allowed paramedics to take patients to these alternate destinations. According to a 2018 document from the National Association of State EMS Officials, only 16 states had laws or regulations enabling community paramedicine.

Paramedics often have extensive knowledge and training, but historically their skills have been underutilized. It is time that our laws recognized that paramedics are capable of much more than just hauling people to the hospital.

Localities should begin preparing to apply to participate in the new Medicare payment model – learning about the funding opportunity, the requirements, and the application process.

There are a number of issues to consider, including what services should be offered, who should provide the services, and whether additional staff are needed. Of course, localities should lobby state officials to remove any legal or regulatory prohibitions on community paramedicine.

Due to the high cost of so many things in the healthcare sector, one might expect community paramedicine programs to be costly; but, in fact, they are surprisingly affordable.

According to a 2017 survey, over half of these programs cost $100,000 or less, and an overwhelming majority cost $300,000 or less. In other words, the annual cost of a community paramedicine program is typically less than the cost of a single new ambulance.

Furthermore, some of these programs have been able to generate revenue to help offset program costs even without Medicare payments. (For example, some Medicaid and private insurance plans pay for some services provided by community paramedics.)

The new payment model will be a win-win-win for Medicare patients, taxpayers, and health professionals. Patients should receive faster care with lower out-of-pocket costs – possibly in the comfort and convenience of their own homes.

By delivering care to more patients in their homes, at doctor’s offices, and at urgent care centers, costs to taxpayers should be reduced.

Finally, by diverting patients with minor ailments or injuries away from emergency rooms, hospital staff should be less stressed and better able to deliver care to those who need it most.

State officials should move quickly to ensure that state laws and regulations empower paramedics to deliver a wider range of services to patients, and localities should work to establish or expand community paramedicine programs and apply to participate in the new Medicare payment model.


Richard McCarty is the Director of Research at Americans for Limited Government and serves on the Republican State Central Committee.