The CMMI (Center for Medicare and Medicaid Innovation) has announced a new payment model for emergency ambulance services that will test Medicare paying for emergency care after someone dials 911—including through telehealth.
According to federal announcement this week, the new voluntary model, the Emergency Triage, Treat and Transport (ET3) model, will make it possible for participating ambulance suppliers and providers to partner with qualified healthcare practitioners to deliver treatment in place—either on-the-scene or through telehealth—and with alternative destination sites, such as primary care doctors’ offices or urgent-care clinics, to provide care for Medicare beneficiaries following a medical emergency for which they have accessed 911 services.
The aim, according to the feds, is to engage healthcare providers across the care continuum to more appropriately and effectively meet beneficiaries’ needs. Additionally, the model will encourage development of medical triage lines for low-acuity 911 calls in regions where participating ambulance suppliers and providers operate. The ET3 model will have a five-year performance period, with an anticipated start date in early 2020, officials noted.
Currently, Medicare primarily pays for unscheduled, emergency ground ambulance services when beneficiaries are transported to a hospital emergency department (ED), creating an incentive to transport all beneficiaries to the hospital even when an alternative treatment option may be more appropriate. To counter this incentive, the ET3 model will test two new ambulance payments, while continuing to pay for emergency transport for a Medicare beneficiary to a hospital ED or other destination covered under current regulations, officials offered:
• Payment for treatment in place with a qualified healthcare practitioner, either on-the-scene or connected using telehealth; and
• Payment for unscheduled, emergency transport of Medicare beneficiaries to alternative destinations (such as 24-hour care clinics) other than destinations covered under current regulations (such as hospital EDs).
“This model will create a new set of incentives for emergency transport and care, ensuring patients get convenient, appropriate treatment in whatever setting makes sense for them,” HHS (Department of Health & Human Services) Secretary Alex Azar. “Today’s announcement shows that we can radically rethink the incentives around care delivery even in one of the trickiest parts of our system. A value-based healthcare system will help deliver each patient the right care, at the right price, in the right setting, from the right provider.”
According to federal officials, the ET3 model encourages high-quality provision of care by enabling participating ambulance suppliers and providers to earn up to a 5-percent payment adjustment in later years of the model based on their achievement of key quality measures. Qualified healthcare practitioners or alternative destination sites that partner with participating ambulance suppliers and providers would receive payment as usual under Medicare for any services rendered.
This one of the first major innovation initiatives for CMMI director Adam Boehler, who has been in this role for less than a year, and who touched on payment incentive issues when he spoke with press at HIMSS19 in Orlando this week. There, Boehler said, “When you call 911 and the ambulance comes, it’s only paid if you go to the hospital. Now, I don’t want people not to get to the hospital when needed; but if you wanted to treat them at home under physician supervision, you could. We’re looking at this.” Importantly, he also noted, 40 percent of Medicare hospital admissions come through 911. “It’s a huge issue,” he said, and “a very simple change [in payment incentives] could make a difference.”
In a statement on the new model’s introduction, the Charlotte-based Premier noted that curbing unnecessary ED use “presents an opportunity to reduce costs and deliver patient care in the most appropriate setting. Instead of trying to solve these issues in the middle of an emergency, we believe it is best to address them further upstream in the care continuum.”
A recently released Premier analysis revealed that more than 4.3 million ED visits, costing an estimated $8.3 billion, were potentially preventable. This suggests more effective primary care management is necessary, Premier officials said.
Blair Childs, senior vice president of public affairs, Premier, said, “Our work with more than 120 ACOs [accountable care organizations] has shown that developing a patient-centric, cross-continuum care management model in partnership with primary care providers can prevent inappropriate ED visits and deliver high-quality care.” He added, “We encourage CMS to enable ACOs to partner with ambulance providers and local government to implement the aspects of this model within the ACO, allowing the ACO to be accountable for the full continuum of care. We encourage CMMI to continue to invest in models that align incentives across the care continuum to prevent avoidable and costly visits to the ED.”
