Physician's assistant program coming to North Mason

Chief believes program could become model

Matt Baide | Dec 01, 20220

The North Mason Regional Fire Authority is launching a physician’s assistant program in 2023, hoping to fill a need for medical services in the community.

NMRFA Chief Beau Bakken said the authority was looking to start a similar program before COVID hit, but the logistics were too complicated at the time. The pandemic did allow time to plan on how to execute the program.

The intention of the program is to fill a gray area in coverage. When NMRFA responds to a call for medical attention, it has two options: Take the person to the emergency room or send them home and tell the patient to follow-up with a primary-care provider.

“We just said there is a good portion of our patients, I believe it’s 35% to 40% of our patients, who don’t need to be seen in an emergency room, they need something a little bit more than following up with their primary care provider in a couple of weeks and we aren’t treating them as best we can with our two modalities,” Bakken said. “What we’re seeing with a lot of our patients that stay at home is there’s a period where if you’re not attending to something, let’s say a routine infection, but a routine infection treated with some antibiotics early on, if you do get that primary care, if you do get that treatment relatively early on, you go and delay that for three or four weeks, and that happens a lot … certainly during the end of COVID, we were becoming the health care system for North Mason, but you delay that treatment and now you’re into a really life-threatening mode when really what you needed up front was just some really basic intervention.”

From an economic standpoint, Bakken said the program will save money. Emergency room visits cost about $3,500 and higher across the board, according to Bakken.“Is there a level of care here we can provide in North Mason and we think the answer is yes by this PA program,” Bakken said. “There’s certainly some finances behind this as well. What we ultimately want to see happen is that this is a lot less costly for the hospitals themselves. We’d like to see them support this program long term and also for the insurance companies. Insurance companies are paying the bill on behalf of their beneficiaries and what’s better to pay, a visit or two from our PA or that $5,000 hospital bill?

”If a patient needs to be taken to the ER and then discharged, they can leave with prescriptions and a list of directions on how to continue to get well at home. Bakken said this can be confusing for some patients because they don’t understand their follow-up care and then they are calling 911 to go back to the ER. The PA would also follow up with people on how they are doing with their follow-up care.

NMRFA joined with Mason County Public Hospital District No. 2 to help fund the program. After a year of talking with the district and fine-tuning details, the interlocal agreement was signed by the two parties at a meeting Nov. 15 at the fire station in Belfair for the program to start Jan. 1.

Superintendent Sandra Robertson said the hospital district has joined with NMRFA throughout the years on projects. She said this fills a need in the community.

“When we were approached by Beau with this idea, I was elated. It was one of these, just the potential, was almost mind-boggling on where this could go,” Robertson said. “Beau had approached me one-on-one with this and then we took it to both boards and just went from there. It’s just the potential to help people that live in this area because when you get into a rural area, a lot of times, transportation is an issue for people. They just don’t have the ability.”

Robertson said the health care system can be difficult to understand and this will give community members “a hand to help walk them through.”

NMRFA has already hired physician assistant Adam Boyd, a Bremerton native who has experience as a firefighter and EMT in North Mason. He started at the beginning of November and has been getting his office set up to see patients.

“I’m expecting to really have to get creative with things. Currently, I’m trying to look around the U.S. just to see if there’s anything that’s been modeled after what we’re doing and we’re just not finding it,” Boyd said. “This is a chance to get really creative. When I was working in primary care, I just saw there was this aspect where providers were not really given an adequate amount of time so we’re dealing with multiple issues, multiple complaints in one 10- to 15-minute visit so I think the time aspect is going to be really crucial when we get out there. That’s where we’re really going to be able to make a change in these people’s lives.”

Boyd said it is exciting to be one of the first fire authorities to try this program, but it also creates complications because of unforeseen problems.

Bakken said he believes the program has the chance to become a model for other rural communities in Washington.“

It is a bit of throwing spaghetti on the wall,” Bakken said. “I think it’s really important to point out we are not becoming primary-care providers. What this really is is to be an intermediary between the 911 system that is to some degree becoming the health care system for rural communities. It’s not unique to us, but you’re trying to create a bridge between the 911 system and primary care. How does Adam help you get toward primary care? As Sandy was saying, it is complex, it is challenging, how do I navigate insurance? The scheduling, facilities, clinics, referrals, medications, the list goes on. Adam is going to become the advocate for folks that are out there and help them with those things.”Boyd said his top objectives for the program are to prevent hospital readmissions, and provide opioid education and intermediary care. He also hopes to educate people on when to and when not to call 911.

He will work during the day and could respond to emergency calls if needed and he will be receiving a vehicle so he can follow up with patients who need care. NMRFA received $337,000 from the county’s American Rescue Plan Act money and is putting it toward the program, including purchasing a vehicle.“

I have a supplies list, it’s getting longer by the day but I think we’re going to start pretty basic right now and build on,” Boyd said. “We know there’s going to be wound-care stuff. I’d like to see a lot of people who are having difficulties with changing their dressings. I’m going to be involved in some wound-care classes to get up to date on what wound-care specialists are doing so I can bridge that gap from they’re at home to let’s get you to your primary to let’s get you into a wound-care specialist. Let’s not have this turn into an amputation.”

Bakken said this is a pilot program, but he believes in the ability for other rural communities to adopt something similar if it goes the way he hopes.“What I’m very proud of is that we’ve run into a whole host of obstacles. Whether it be licensure, whether it be funding, whether it be equipment purchasing, whether it be insurance and we have blasted through every one of those,” Bakken said. “I think in other communities that might have seen the opportunity to go down this probably got up against some of those challenges and said it’s just not happening. But I have a feeling they will sit there and say somehow, North Mason blasted through these and what results are they producing. If you just do the math, we did the math earlier, if you can keep 30 patients out of the hospital, the program is paid for for the year. Thirty patients, that’s a decent amount as far as numbers but we’re going to be better health care in the community, dollars ahead, with really good people.”

Robertson said she has talked about the program with Mason County Hospital District No. 1 and noted they are interested in doing something similar. She said the state Department of Health is going to be watching the results of this program.“

People are going to come to us,” Robertson said. “Once they know about this and see positive data, which I have no doubt it’s going to be nothing but positive, that they’ll be coming, knocking, saying how did you guys do this? Our hope and our desire and our vision is that this will expand.”

Bakken said the program is the best thing since the fire service introduced EMTs in the early 1970s. He said he hopes to reduce their transports by 40% per year in a couple of years, once the program is in a rhythm and has established protocols.

Boyd said he is ready to get the program started, but he is staying patient for Jan. 1 while also ensuring he has everything necessary to make the program successful.

Bakken said this is one problem NMRFA had during COVID and believes this program will be one of the good things to stem from the pandemic.“

If (COVID-19) is not life-threatening, keep them out of the emergency room and treat them at home and I’m going, ‘Wow, I’ve never seen this before,’ ” Bakken said. “That’s what got the conversation rolling of ‘Hey, if we’re doing that for COVID patients who we don’t see as being life-threatening, there’s a whole host of other patients who can be treated with the right individual in the right circumstance and also left at home not to back up the emergency room.’ It’s a changing dynamic and what I like to think is that there are some good things that are emerging from COVID and this program is hopefully going to end up being one of them.”