The community paramedicine program continues to increase the quality of life of Madison County residents.
The program began in 2024 and aims to address patient concerns through collaborating with community organizations and stakeholders. Issues such as preventing falls and injuries, managing medications and food insecurity can be addressed. By getting to the root cause of the problems, the patient’s quality of life is improved and non-transportable 911 calls, which are not eligible for revenue recovery, are reduced.
Little more than a county-provided cell phone and laptop was used to start the program, along with the use of a loaned vehicle. During this year’s budget discussions, supervisors opted for fund the program at a cost of approximately $110,000 annually including allowing paramedic Tiffany Rannebarger to focus on it full-time. Rannebarger was the one who pitched the idea to create the program and had been working on it in a part-time capacity.
On Tuesday, Rannebarger gave a board-requested 90-day update. She said 39 patients had been served with 29 in-person visits and 24 resource referrals. Those responding to an emergency call are able to complete a form on-scene allowing the patient to quickly be referred to the program. A new risk stratification score has been implemented to allow Rannebarger to triage patients better, streamlining the process and increasing efficiency. There is also a QR code which can be used by the public to create a referral.
Rannebarger said one of the patients served was complex, with 32 different referral points. They had been transported to the hospital for a heart attack, but signed out against medical advice because they had two dogs at home. Through the community paramedicine program, that person, who is a diabetic and wasn’t able to afford their medication, now receives their prescriptions for free by mail. They are also now able to cook via the donation of an oven as they only had a microwave.
“This is an example of improving a person’s situation that you can’t put a dollar amount on,” she said. “Making phone calls and lining up resources can change someone’s life.”
Rannebarger said referrals to the department of social services, Encompass Community Supports and even Hospice of the Piedmont can assist patients with things she can’t. She said social services can help with food insecurity by coordinating with the MESA Food Pantry. Encompass offers a meal on wheels program and substance use referrals.
“Anything out of our purview we do our best to line them up with someone who can do that,” Rannebarger said.
She is working on creating an access model with Rappahannock Health for a remote monitoring and telehealth program. Patients who have Medicare A and B would be provided monitoring equipment for free which would be used to monitor vitals via Bluetooth for a year. Those vitals would be used to determine if interventions are needed.
“This would be a huge opportunity,” Rannebarger said. “It would enable us to take our results and show at the federal level outcome based measures to decrease unnecessary hospitalizations and ambulance use.”
Rannebarger is also hoping to add other services for patients such as home repair needs. She said some patients have needs that aren’t medical such as replacing broken steps.
“I’d like to find someone with the time and effort able to fulfill that need,” Rannebarger said.
The program could soon see a funding boost as well. The county applied for a piece of the state’s federal funding through the Rural Health Transformation Fund. Virginia received nearly $190 million to address rural health care access challenges and health care disparities. A portion of the funding was earmarked for community paramedicine. Rannebarger applied for a competitive grant of approximately $261,000 that would fund a part-time provider, program vehicle and supplies and fall prevention equipment. Awards are expected to be announced on or after Nov. 13. Senator Bryce Reeves endorsed the grant application. During a recent legislative priorities meeting held at the Madison Fire Hall, he said the program was phenomenal.
“The Big Beautiful Bill cuts services to those who need resources the most,” he said. “You guys going out first is going to save a ton of money.”
