CMS Announces New Ambulance Emergency Triage, Treat and Transport Payment Model
On February 14, 2019, the U.S. Department of Health and Human Services (HHS) Center for Medicare and Medicaid Innovation, announced the launch of an innovative payment model with new treatment and transport options to more appropriately and effectively meet Medicare beneficiaries’ emergency needs. The Emergency Triage, Treat and Transport (ET3) Model is a voluntary, five-year payment model that aims to allow Medicare Fee-For-Service (FFS) beneficiaries to receive the most appropriate level of care at the right time and place.
The ET3 Model will provide greater flexibility to ambulance care teams to address the emergency health care needs of Medicare beneficiaries following a 911 call. Under the ET3 model, CMS will pay participating ambulance suppliers and providers to:
- Transport an individual to a hospital emergency department (or other destination covered under the current regulations);
- Transport to an alternative destination (such as an urgent care clinic or primary care provider’s office); or
- Provide treatment in place with a qualified health care practitioner, either on the scene or using telehealth.
In order to make these treatment options possible, ambulance care teams are encouraged to partner with qualified health care practitioners to deliver treatment in place, either on the scene or through telehealth. The model promotes collaboration of providers across the continuum of care. Local governments are also encouraged exercise more authority over 911 dispatches and create medical triage lines for low acuity 911 calls.
Why is the ET3 model important?
Currently, Medicare only allows for payment of emergency ground ambulance services when individuals are transported to hospitals, skilled nursing facilities and dialysis centers. This results in Medicare beneficiaries being transported to one of these facilities even when a lower-acuity treatment may meet the beneficiary’s needs. A White Paper released by HHS estimated that Medicare could save $560 million per year by transporting individuals to doctors’ offices rather than a hospital emergency department. The ET3 model may also result in lower out of pocket costs for Medicare beneficiaries.
Who can participate?
The main participants in the ET3 Model will be Medicare-enrolled ambulance service suppliers and hospital-owned ambulance providers. CMS will use a phased approach through multiple application rounds to maximize participation in regions across the country. CMS anticipates releasing a Request for Applications in Summer 2019 with an anticipated start date of January 2020.