DEPARTMENT: San Antonio Fire Department
DEPARTMENT HEAD: Charles N. Hood
COUNCIL DISTRICTS IMPACTED: City Wide
SUBJECT:
FY 2021 STRAC MIH Acceptance of Funds
SUMMARY:
An ordinance authorizing the acceptance of $1,910,179 from the Southwest Texas Regional Advisory Council (STRAC) for Trauma for services to be provided by the San Antonio Fire Department Mobile Integrated Healthcare (MIH) Unit, appropriating funds and authorizing budgets. The services provided by the MIH Unit with this funding include:
A. Hospice Services in the amount of $500,000 for the period ending September 30, 2021
B. Acute Care Station Services at Haven for Hope in the amount of $301,127 for the period ending December 31, 2021
C. Program for Intensive Care Coordination (PICC) Services in the amount of $319,774 for the period ending December 31, 2021
D. Medication Assisted Treatment (MAT) Services in the amount of $470,111 for the period ending September 30, 2021
E. Texas Targeted Opioid Response (TTOR) Services in the amount of $319,167 for the period ending September 30, 2021.
BACKGROUND INFORMATION:
The Southwest Texas Regional Advisory Council (STRAC) for Trauma was established to facilitate the development, implementation, and operation of a regional comprehensive trauma and emergency healthcare system based on accepted standards of care to decrease morbidity and mortality. Funds from STRAC are awarded to assist in improving the functionality of EMS agencies in the State of Texas.
A. Hospice Services STRAC has created an MIH consortium for municipalities engaged in programs and can act as a clearing house for HIPAA compliant information as well as a central hub for grants for participating jurisdictions within the consortium. Currently the City of San Antonio City and the City of Schertz are the founding members of the consortium. STRAC has received funding from several hospice agencies to help improve the health, comfort and well-being of hospice patients by providing skilled patient care in the home setting, educating the patient, family and caregivers, coordinating with the patient’s hospice provider and reducing admission to emergency rooms throughout the city. The program leverages existing infrastructure and a newly developed notification system to alert hospice agencies when enrolled patients contact EMS, improving situational awareness and allowing MIH Personnel and hospice agency staff to quickly and efficiently respond to meet the needs of the patient based on their current care plan. These funds will be disbursed to the City of San Antonio based on patients enrolled within the geographical boundaries of the City of San Antonio. Through the contract with STRAC, hospice services will be provided to Adoration Hospice Care of Texas D.B.A. Embrace Hospice, Holy Savior Hospice, Alamo Area Hospice, Guiding Light Hospice, and Shepherd Living Hospice D.B.A Four Seasons Hospice
Funds received through this program are paid to the City on a monthly, per patient basis.
B. Acute Care Station Services at Haven for Hope STRAC has received funding from Methodist Healthcare Ministries and other private hospital funding sources to help improve the health and daily activities of residents utilizing services at Haven for Hope and reduce admissions and/or readmissions to hospital Emergency Rooms throughout the city.
The MIH program responds to Haven for Hope medical calls and provides services on-site. The MIH Acute Care Station operates from 8pm until 12am where patients are triaged. Patients that are triaged in the evening receive priority appointments in the morning at the Centro Med Sarah E. Davidson Clinic. Since the launch of the pilot program on July 1st, 2018 and through November 1st, 2020 the Acute Care Station MIH Paramedics have seen 1,998 patients and have maintained an EMS transport rate of 20% during operational hours. In the absence of the MIH Paramedic during the daytime hours the EMS transport rate remains at 62%. With a renewal of this program it is projected that the Acute Care Station MIH Paramedics will see 800 patients from January 1, 2021 through December 31, 2021.
C. Program for Intensive Care Coordination (PICC) STRAC has received funding for the Intensive Care Collaboration (PICC) Program from the South Texas Crisis Collaborative (STCC), which is comprised of various healthcare systems and philanthropic organizations to reduce the number of high-volume emergency detentions to local hospitals.
In 2018 there were over 14,000 emergency detentions by the San Antonio Police Department (SAPD) that were routed to local hospitals utilizing STRAC’s law enforcement navigation system. In 2019 there were 20,313 Emergency Detentions by the San Antonio Police Department (SAPD) that were routed to local hospitals utilizing STRAC’s law enforcement navigation system.
Launched in July 2019 the PICC program has been able to connect with 250 clients with a total of 13,229 visits, which has contributed to a reduction in Emergency Detentions by SAPD. The PICC program utilizes two (2) SAFD MIH paramedics who work side by side with the Local Mental Health Authority-Center Health Care Services (CHCS) personnel to connect with a high-volume utilizer during the pre and post mental health crisis. A representative from SAFD MIH and the Local Mental Health Authority initially meet with each new high-volume utilizer to create a care plan for that individual. Once a care plan is developed the PICC team work to keep the high-volume utilizer out of crisis and in care. MIH assists with case management for high volume utilizers who need services. The PICC team continues to focus on 100 of highest utilizers who have been emergency detained more than six (6) times in the last six months or three (3) times in the last month.
D. Medication Assisted Treatment (MAT) STRAC has received funding from Texas Targeted Opioid Response (TTOR) to help improve the outcomes of citizens that have suffered narcotic overdoses through Medication Assisted Treatment (MAT) from opiate dependence.
San Antonio Fire Department (SAFD) Mobile Integrated Health Paramedics have been providing education, Narcan harm reduction, and referral to treatment for opiate overdose patients through funding with the Texas Targeted Opiate Response (TTOR) program with noted success. The Fire Department’s unique community acceptance and trust allows them better access to patients and their families in order to disrupt the cycle of opioid dependence and facilitate referral into treatment.
The MIH program has identified a need in the current referral process. The MAT program addresses withdrawal treatment in a timely manner which is a significant barrier for intake and compliance with Medication Assisted Treatment (MAT) from opiate dependence. Patients are psychologically distracted and physically ill due to symptoms of narcotic withdrawal and/or severe cravings and are unable to begin or complete a recovery program. This MIH MAT program starts immediate medication assisted treatment with administration of Buprenorphine (Suboxone) sublingual titrated to symptom control as a value-added treatment with subsequent referral, facilitated intake, and transportation to an available recovery clinic. Alternative medication therapy with Clonidine (an inexpensive blood pressure medication with weak mu-opioid receptor agonist activity) along with Zofran and Benadryl is also an available option. Since inception of the program MIH paramedics completed over 1,110 home visits to 523 identified patients, with this donation MIH paramedics are expected to complete an additional 1,524 home visits to 720 unique patients. In the program the MIH MAT team focuses on anyone who is suffering from acute opioid withdrawal.
The goal of this program is to stabilize symptoms quickly, so the patient can mentally attend and participate in a facilitated admission process to an inpatient/outpatient detoxification and recovery program.
E. Texas Targeted Opioid Response STRAC has received funding from Texas Targeted Opioid Response (TTOR) to help improve the outcomes of residents that have suffered narcotic overdose.
In Texas, Bexar County ranks third in per capita rates of death from opioid overdoses. The MIH program utilizes two (2) MIH paramedics to connect with individuals, identified by SAFD personnel while providing EMS services, as being at high risk for overdose with induction and engagement into recovery support services. Since inception of the program MIH paramedics completed over 3,292 home visits to 1,676 identified patients, with this donation MIH paramedics are expected to complete an additional 2,009 home visits to 1,115 unique patients. The follow up visit is educational regarding the use of Narcan, clean needles, risks of continued drug use, and available options. CPR training can also be offered to the family as well as Narcan delivery training.
ISSUE:
This ordinance authorizes the acceptance of funds from STRAC in the of $1,910,179 to support services provided by the San Antonio Fire Department Mobile Integrated Healthcare (MIH) Unit. The services include Hospice, Acute Station at Haven for Hope, Program for Intensive Care Coordination, Medication Assisted Treatment, and Texas Targeted Opioid Response. The funds will be used primarily for overtime expenses and medications.
ALTERNATIVES:
The funding provided by STRAC increases the efforts of the San Antonio Fire Department Mobile Integrated Healthcare (MIH) to provide additional services to San Antonio Residents. No other funding alternatives have been identified at this time to provide these additional services.
FISCAL IMPACT:
Funds in the amount of $1,910,179 is authorized to be accepted from STRAC and appropriated for the following projects:
A. Hospice Services - $500,000 for overtime expenses.
B. Acute Care Station Services at Haven for Hope - $301,127 for overtime, medications, and auto expenses.
C. Program for Intensive Care Coordination (PICC) - $319,774 for overtime expenses.
D. Medication Assisted Treatment (MAT) - $470,111 for overtime and medication expenses.
E. Texas Targeted Opioid Response (TTOR) - $319,167 for overtime expenses.
RECOMMENDATION:
Staff recommends approval of this ordinance and acceptance of funds.