Programs to reduce repeat 911 calls are valued, but face obstacles to expansion, audit finds

Programs to get people needed health care short of calling emergency services have been effective, but communities across Washington face obstacles to starting such programs, a new performance audit found.

Local fire departments respond to 911 calls by sending emergency medical personnel, but many calls are for nonemergency ailments, including chronic medical conditions. The Office of the Washington State Auditor reviewed Community Assistance Referral and Education Services (CARES) programs, which aim to reduce repeat 911 calls and their associated costs by providing patients with more appropriate care.

Auditors identified 52 CARES programs across the state, surveyed more than 250 fire agencies, interviewed several rural fire districts and analyzed healthcare usage data. They also conducted case studies of eight programs. Among their findings:

• Most CARES programs specifically serve people who repeatedly call 911. Instead of simply transporting them to hospital emergency rooms, program staff connect clients to services such as behavioral health services, home health care providers, or others who can help with issues like housing and transportation.
• CARES programs can reduce avoidable ambulance trips, ER visits and hospital readmissions. But in doing so, fire agencies absorb costs that would otherwise have been borne by hospitals and insurers.
• Statewide, almost one-third of fire agencies surveyed participated in a CARES program, which were based primarily in urban and suburban communities. Meanwhile, only one-sixth of rural fire agencies participated in a program.
• Nevertheless, almost half of the fire chiefs without a program thought their community needed one, including in rural areas.
• Agencies cited insufficient funding as the most critical barrier to starting a CARES program. Funding is also a challenge for existing programs: nearly three-quarters of programs surveyed said they were at risk of having insufficient funding in the next five years.

The report includes recommendations to better coordinate and reimburse CARES programs, and to make them easier for local fire agencies to launch.

“Washington needs more of these programs,” said State Auditor Pat McCarthy. “This report contains rich, detailed stories from those working in the field right now. And we list a series of recommendations to a wide variety of stakeholders, all of whom told us they welcomed our work and valued an outside, independent view into further improvements.”

The full report and summary material can be found on the State Auditor’s Office website: Reducing Nonemergency Use of Emergency Systems performance audit.

Media questions: Assistant Director of Communications Adam Wilson, Adam.Wilson@sao.wa.gov, 564-999-0799.