Health Reform WK-EDGE Applicants selected for new emergency treatment and transport payment model
Tuesday, March 10, 2020

Applicants selected for new emergency treatment and transport payment model

By Rebecca Mayo, J.D.

CMS has selected applicants to participate in the Emergency Triage, Treat, and Transport payment model that will allow ambulances to provide emergency care and transport to alternative destinations.

The new Emergency Triage, Treat, and Transport (ET3) model is a five-year payment model that allows greater flexibility to ambulance care teams to address emergency health care needs of Medicare fee-for-service beneficiaries. CMS has selected 205 Medicare-enrolled ambulance services suppliers or ambulance providers in 36 states and the District of Columbia to participate in the model. According to CMS, the program is expected to begin in the spring of 2020, which will allow the selected participants to establish the partnerships needed to implement the interventions.

Existing model. Under the existing payment model, Medicare only pays for emergency ground ambulance services when beneficiaries are transported to specific types of facilities, most often a hospital emergency department. However, many patients do not require the level of care offered by an emergency department and may be better served by receiving care at an urgent care or primary care physician’s office. Avoiding transport to a hospital emergency department may allow beneficiaries to avoid hours in the emergency department as well as reduce exposure to hospital-acquired conditions. Additionally, HHS previously estimated that Medicare could save $560 million per year by transporting individuals to doctor’s offices rather than a hospital emergency department.

Proposed models. The proposal includes triaging emergency transport requests at two levels.Under the proposed system, when a caller reaches 911 an ambulance will be dispatched, or the caller will be transferred to the medical triage line. On the medical triage line, the caller will consult with a health care professional.

When an ambulance arrives on the scene, they may triage Medicare beneficiaries and decide to transport a beneficiary to an emergency department, a primary care doctor’s office, an urgent care clinic, or to initiate and facilitate treatment in place. Treatment in place may involve treatment by a qualified health care practitioner in-person on the scene or via telehealth.

Funding. The ET3 model was developed through the Center for Medicare and Medicaid Innovation, which is funded through the Patient Protection and Affordable Care Act (ACA). It will be a five-year payment model that will allow the ambulance providers and suppliers to receive Medicare payment for transport to one of the approved alternative destinations or providing care in place. CMS will also issue a Notice of Funding Opportunity (NOFO) for up to 40 two-year cooperative agreements for state and local governments to fund the implementation of medical triage lines integrated with the Primary or Secondary Public Safety Answering Point in an eligible region.

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