Doctors, hospital administrators, and emergency healthcare officials urged the Legislature Wednesday to expand in-home visits for Virgin Islanders’ routine and health maintenance care.
A version of the proposed mobile intergraded healthcare program was already in use on St. Croix to great effect, said Sen. Marise James, who’s sponsored a bill expanding the service to St. Thomas and St. John.
“In its simplest definition, MIH is a provision of health care using patient-centered mobile resources in the out-of-hospital environment,” James said.
James’ bill covers planned, scheduled medical services, including consultations on proper in-home care for various medical conditions that patients or their families can perform. This sort of preparation and preventative care can reduce 911 calls, she said. It would also include pre- and post-hospitalization attention.
“By reducing the demand for EMS resources in non-emergency cases we can create a more sustainable and fiscally responsible healthcare system,” James said.
Mobile integrated health is an umbrella term for strategies of care, she said.
Practitioners work in concert with hospitals, private doctors, government agencies, emergency services, and even families with questions or needs, said Jacqueline Greenridge-Payne, acting director of Emergency Medical Services and administrator of the Health Department’s mobile integrated healthcare community paramedicine program.
“Our mission is saving a community one person at a time,” Greenridge-Payne told senators at the meeting of the Health, Hospitals and Human Services Committee. The MIH team goes to people’s homes to advise on best practices for taking care of various health problems, proper diet, creating healing environments, and light medical care. “It’s a total wraparound service,” she said.
Health Department Commissioner Justa E. Encarnacion’s estimated price tag to implement the program territory-wide would be roughly $1.25 million. In St. Croix, the program had enrolled 1,892 patients. Sixteen more may soon be added, she said.
“The rising demand for emergency medical services due to an aging population and a declining workforce in the Emergency Medical Services sector has created a significant challenge for many communities in fulfilling the healthcare needs of our most vulnerable population, especially the elderly,” Encarnacion said.
The median age in the U.S. Virgin Islands is 45.9 — seven years older than the U.S. mainland’s median age, she said. More than 21 percent of Virgin Islanders are older than 65.
But an aging population in increasing need of healthcare is compounded by an underinsured and uninsured population.
Approximately 29 percent of the U.S. Virgin Islands is uninsured and about 22 percent is below the federal poverty line, Encarnacion said.
“Repeated hospital and emergency room visits for indigent care are economic and social problems that plague our government,” she said.
Young people and those with medical experience can also benefit from the program, health officials said.
Cora L.E. Christian — the first woman from the U.S. Virgin Islands to earn a medical degree and former assistant commissioner for Prevention, Health Promotion and Protection — had to upend her life when her husband, University of the Virgin Islands educator Simon Jones Hendriksen, had a stroke in 2016.
“We don’t have the services in the Virgin Islands to take care of individuals who are fragile. So I had to leave my practice,” Christian said in a video-taped message. “It completely changed our life.”
The MIH program allowed for Christian and family to resume a level of normalcy, get needed vaccines at home, and have support needed to thrive.
“Everybody needs to support this program because it helps the people who are most fragile,” she said.
Tina M. Comissiong, CEO of Schneider Regional Medical Center, said her St. Thomas hospital sees some 17,000 emergency room visits a year and Myrah Keating Smith Community Health Center on St. John sees more than 6,500.
“Expanding access to preventative and primary care will positively impact the overall healthcare system of the territory. It will help people get seen and screened earlier so they do not present to the hospital in an advanced state in their disease. It will also help to decrease the volume of patients who presently rely on the emergency departments for their primary care,” Comissiong said.
Tess Richards, the interim executive director at St. Thomas East End Medical Center Corporation, said with the appropriate staffing and processes in place, a Mobile Integrated Health program would help resolve issues that have plagued the territory’s health system.
Too many people inappropriately rely on emergency rooms, Richards said. Some aren’t sure if they have a true emergency, so they seek care at the emergency department to be safe. Others don’t have a primary care provider, so they assume their only option is to seek care at the hospital.
“With the proper support, The MIH team can facilitate provider and patient connection to coordinate the needs of patients so that patients without PCPs can easily be linked to care and have appointments scheduled in real-time,” she said. The system could also reduce costly and dangerous re-hospitalizations through in-home reviews of discharge instructions, medication supply and instructions, and making follow-up appointments.
“MIH team members can perform a needs assessment to address the whole patient. Evaluating the patient’s social needs and evaluating the home can result in decreased infection and fall rates. Addressing the whole patient will help bridge any gaps in patient care and safety for our vulnerable population,” Richards said.
Reducing emergency department visits will save money for everyone while resulting in better overall health, she said.
Lisle Evelyn Jr., assistant director of Virgin Islands Fire Service on St. Thomas, said of the emergency calls his department gets, only about 20 percent of calls received require further medical assistance.
“We believe that MIH programs have the potential to revolutionize healthcare delivery in our community and address critical healthcare needs,” Evelyn said.
Currently, Virgin Islanders have trouble getting regular, preventative medical assistance because of geographic isolation and transportation limitations. This leads to difficulty managing chronic disease. Likewise, mental health issues often go untreated.
“The need for mobile healthcare services in the Virgin Islands is evident,” he said.
Sen. Novelle E. Francis Jr. said the measure was a welcome step back in time to when doctors and nurses regularly visited people in their homes.
“This is what use to be done back in the days. We’re just going backward. My mom was a nurse, a public health nurse. And she was the neighborhood nurse. She was responsible for administering insulin and B12 deficiency and all these type of things. So this is just a matter of going back to our roots,” Francis said.
