Care Transformation Center Blog

3 ways EMS and hospice can partner on end-of-life care

by Eric Sun

A subset of patients on hospice ends up visiting the ED or admitted to the hospital while enrolled in the program. These visits can lead to unwanted treatments, revocation of a patient’s hospice status, and significant costs for hospice agencies.

I recently co-presented a webconference with Dr. Kevin Munjal, Chair of the New York Integrated Healthcare Association and Associate Director of Prehospital Care at Mount Sinai Health System, and Dr. Ritchell Dignam, Hospice Consultant at Visiting Nurse Service of New York, on how hospice agencies can partner with EMS agencies to address this issue. Below are some three of the key takeaways from the presentation.

Improved coordination and communication between EMS and hospice during 911 calls can prevent avoidable ED visits and hospitalizations for hospice patients.

In a unique program developed by MedStar Mobile Healthcare and Vitas Healthcare, hospice patients who call 911 receive a visit from a community paramedic who can assess the patient, administer their comfort pack medications, and assuage family concerns. Then, a hospice nurse comes to the patient’s home and takes over patient monitoring. By providing care that is consistent with the patient’s care plan, the community paramedic helps alleviate the patient’s and family’s concerns and helps avoid a transport to the hospital.

Program sustainability requires a shift from current fee-for-transport EMS reimbursement to alternate payment models, such as population-based funding.

Currently, most EMS agencies receive payment for transports to the hospital only. Shifting to a population-based per-member-per-month (PMPM) payment can help justify the business case for developing these programs and free up EMS agencies to work with hospice agencies in a more collaborative manner.

EMS agencies are uniquely positioned to serve as effective partners for hospice agencies and health systems as the health care system shifts to value-based care.

EMS agencies are staffed by trained health care professionals who are based in the community and can respond quickly to resolve health issues. In recent years, they have become more integrated into care teams through community paramedicine programs and supported patients in an expanded role.

For more information on our playbook for building a community paramedicine program, please contact Christina Wild at

Make your patients healthy and your ED happy

See how community paramedics can help extend the care team to achieve system goals of patient engagement and robust care management.