Nurse Practitioner Program

I have recently learned a bit about the Beverly Hills Nurse Practitioner, a fantastic program that our City offers to residents, that I thought I should bring to your attention in case you are not already familiar with it.

First, some background may be helpful. Medical caregivers from paramedics to neurosurgeons are subject to rules called “scope of practice” rules. These rules govern just what caregivers are allowed to do and what they are not allowed to do. The following is a general description of what certain caregivers are allowed to do that is not intended to be all inclusive or specific. Rather it is intended to help you understand the purpose, advantages and limitations of the Nurse Practitioner program.

For paramedics, the scope of practice is limited to transporting patients to emergency rooms and providing some basic life support in a pre-hospital setting. On responding to a 911 call, the paramedics can assess the patient’s condition and, if necessary, take the patient to an emergency room or some other care facility. If a trip to the emergency room was not required, the paramedics would stabilize the patient at home and depart.

Some patients were frequent callers but generally did not require hospitalization; rather, the paramedics would be called repeatedly to treat chronic or other various problems. It was perceived, by Dr. Julian Gold when he was on the City Council, that it was unnecessary and unduly expensive to use paramedics and ambulances for every call. Instead, nurse practitioners could be used.

Nurse practitioners have a far more broad scope of practice than paramedics. Their scope of practice allows them to do the following: take medical histories and perform physical exams; diagnose and manage both acute and chronic conditions; order, perform and interpret diagnostic tests; prescribe medications, including controlled substances; and perform procedures within their training, such as suturing, biopsies and joint injections. In short, they can manage overall patient care in collaboration with or independently of physicians, depending on their licenses.

Thus, Beverly Hills resolved to implement a nurse practitioner program to work in conjunction with the paramedics. The intention was to bridge the gap between the most serious medical problems and the very minor. One of the purposes of this program is to provide proactive care to the most vulnerable in our population. In addition, the nurse practitioners can connect their patients to various social services. Now, Cedars Sinai Medical Center has opened its records so that in appropriate cases, the nurse practitioners can access records.

The Beverly Hills Fire Department nurse practitioners’ responsibilities include: functioning as a clinician providing direct patient care to the ill and injured in the field; conducting and interpreting diagnostic tests; performing basic routine procedures; and prescribing and administering medication.

This is the way that the program works. Once a Beverly Hills resident patient has called 911 and receives a visit from Beverly Hills Fire Department paramedics, the patient is either visited initially by a nurse practitioner who accompanies the paramedics or will receive a follow up contact from the nurse practitioners to determine whether any follow up is needed. If so, the patient will receive a home visit from a nurse practitioner, and in effect will become a patient of that nurse practitioner.

There is no charge for the service and the city bears the entire expense of this program. The City employs five full-time nurse practitioners who are supervised by a physician medical director. They are available seven days a week (excluding holidays) from 8 AM to 6 PM. As you might expect, this program has resulted in a substantial reduction in 911 calls. The nurse practitioners average around 250 patient encounters (in person or by telephone) per month and make house calls every day.

The program is managed by BHFD Emergency Medical Services (EMS) Division Chief Sean Stokes and BHFD Chief Greg Barton. Mr. Stokes takes great pride in this program and explains: “The treasure of this program is that it addresses the disconnect between hospitalization and what the patient can do for himself or herself at home. It provides a greater continuum of care.”

Nurse Practitioner Alea Foster said: “We do not replace emergency calls to paramedics who will transport patients to the hospital. We assess the gap between what the paramedics and the hospitals do. We assess the patient’s needs and mobilize to see patients where they are and provide needed treatment. We do not want Beverly Hills residents to feel alone.”

As far as I can tell, the Beverly Hills nurse practitioner program is unique. This is because at present, neither Medicare, nor Medicaid, nor any other third-party payer will reimburse for the cost of this service. The Beverly Hills nurse practitioner program was implemented in 2019. At the time, it was stated, “we are thrilled to bring this innovative life-saving program to Beverly Hills. With a focus on improving patient outcomes and specific needs, the program is part of the future of mobile medical integrated healthcare.”

Now, other cities around the country are watching as the City of Beverly Hills takes the lead in trying to persuade Medicare and then others to reimburse cities for some or all of the costs of the nurse practitioner program. In the meantime, the City bears all of the costs of this program and does not charge or bill the patients. I am informed that the total costs exceed $1M annually. Whether reimbursed or not, this program is a great benefit for our residents.