President Donald Trump has promised health care will be one of his top priorities in office. Hours after he was sworn in last Friday, he signed his first executive order outlining plans to repeal the Affordable Care Act.
Now while patients and providers wait to see what's next, MedStar ambulance service in Fort Worth is trying its own method to cut costs and offer better care.
Patients spend hours of their lives and thousands of dollars in the emergency room, often for treatment they could get a better way. Plus, under the Affordable Care Act, hospitals can be penalized for patients who are admitted over and over.
So MedStar is setting a model to match the right care with the right price.
When you think of paramedics, an ambulance goes hand-in-hand. But four years ago John Farris traded out the sirens for a sedan and a simple mission.
"Having the right patient get to the right resource at the right time," said Farris, a MedStar community paramedic.
"I love every minute of it," Farris said. "It's the best job in health care."
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He's going back to a method of the past: house calls.
"Howdy howdy. You doin' OK?" Farris said, while walking in to visit Allean Isaac.
Isaac is about to turn 89 years old and needs help managing diabetes and congestive heart failure.
"Beating good and strong," Farris said while checking her pulse.
Isaac was going to the emergency room about once every three months, a costly and inconvenient way to get treatment. Now she gets twice-weekly visits at home from Farris.
"I don't have to sit in the waiting room, wait until they call my name or nothing. They come right here," Ms. Isaac said.
Farris has helped a lot with Isaac's diet. She's lost 11 pounds in three weeks, which has helped bring her health conditions under control. He also sees what's happening in her daily life.
"Which kiddo out of the 12 that you got is coming to see you tonight?" Farris asked.
It's time with a patient, that's getting harder to come by.
"Everybody in health care is having to become more lean and more time-efficient," Farris said.
But that short-term efficiency can lead to long-term costs if a small problem missed in the living room snowballs to the emergency room.
MedStar estimates that over the past three years, it has prevented 66 hospital visits from some of these repeat patients, for a savings of $6,600 per patient.
MedStar was one of the first to start this model. Now it has spread across the country to more than 250 other programs.
