RALEIGH — Some health crises are better - and less expensively - handled without a trip to a hospital emergency department.

At least that's the thought behind Wake County commissioners' vote Tuesday to apply for a nearly $1 million federal grant designed to lower the county's emergency medical costs. The three-year program is part of a $1 billion effort by the Centers for Medicare and Medicaid to lower costs through innovation.

For example, older patients who fall in an assisted living facility could be evaluated and have treatment recommended on the spot, rather than automatically being sent on an expensive trip to an emergency department. In addition, emergency workers withspecial training could decide that certain patients could be transported to a health care facility in a vehicle other than an ambulance.

"We are doing that today in a pilot program, and it is working very well," Dr. Brent Myers, director of Wake County Emergency Medical System said at Tuesday's meeting of the Board of Commissioners.

The county will hear in March whether it will receive the $978,758 available from the federal agency. Wake County also expects to contribute $120,714 of its own funds, a share that will come from user fees.

"Each grantee project will be monitored for measurable improvements in quality of care and savings generated," according to a document describing the Health Care Innovation Challenge.

The Feds expect the project to show cost savings compared to current practice as early as October. A single trip to the emergency room in an ambulance can cost more than $500, according to the Wake Rescue Squad EMS Fund.

Wake EMS has sent more than 200 patients in the last three months directly to behavioral health centers instead of hospital emergency departments, Myers said. All but four were successfully treated without involving a hospital emergency department visit.

In addition, the organization Doctors Making House Calls has taken part in an effort to diagnose patients who fall in their homes or a facility.

"They can come up with a treatment plan rather than automatically taking those patients to the emergency department," Myers said.

In a third phase of the three-year project, patients with less serious problems would be transported to the hospital in a vehicle other than in an ambulance.

"Forty percent of them wind up in the waiting room anyway," Myers said.

Board of Commissioners Chairman Paul Coble noted that the federal dollars will act to speed up a plan that the county had under way to include specially qualified "advanced practice paramedics" in the emergency medical system.

"This is just a way to get these people on the street and in action sooner than we would have," Coble said.

Federal funds will pay for 14 advanced practice paramedics, two supervisors and a grant supervisor if the entire grant is funded.

Goldsmith: 919-829-8929