CMMI to Roll Out More Flexible Payment Model for Ambulance Providers

Feb. 13, 2020
Emergency Triage, Treat, and Transport (ET3) Model will pay ambulance providers to offer treatment in place or transport patients to places other than hospitals

Today Medicare regulations only allow payment for emergency ground ambulance services when individuals are transported to hospitals, skilled nursing facilities, and dialysis centers. This spring, however, the Center for Medicare and Medicaid Innovation will launch a voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare beneficiaries following a 911 call.

Under the Emergency Triage, Treat, and Transport (ET3) Model, the Centers for Medicare & Medicaid Services (CMS) will pay participating ambulance suppliers and providers to transport an individual to a hospital emergency department (ED) or other destination covered under the regulations or transport to an alternative destination (such as a primary care doctor’s office or an urgent care clinic), or provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth.

The model will also encourage local governments or other entities that operate 911 dispatches to establish a medical triage line for low-acuity 911 calls. The ET3 model aims to improve quality and lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports.

A white paper by the U.S. Departments of Health and Human Services and Transportation found that Medicare could save $560 million per year by transporting individuals to doctors’ offices rather than a hospital ED. Accounting for the avoided inpatient hospitalizations and opportunities for treating in place may garner further savings and quality of care improvements.

One health system that has laid the groundwork for participating in ET3 is Northwell Health, New York State’s largest healthcare provider with 23 hospitals and nearly 800 outpatient facilities. As part of its “Independence at Home” program, Northwell’s Center for Emergency Medical Services has developed a nationally recognized community paramedic program capable of bringing highly trained clinicians to assess and treat patients in the home in under 30 minutes.

 “The success of the Independence at Home demonstration and Northwell House Calls has informed numerous other value-based programs, such as the recently announced CMMI demonstrations Primary Care First (PCF), Emergency Triage, Treat and Transport (ET3) and Serous Illness Payment Model (SIP),” noted Kristofer Smith, M.D., Northwell’s senior vice president of population health, in a statement. “The health system will continue to participate in these important programs as we move forward towards our goal of being the highest value provider in the region.”

A CMMI representative recently told the most recent meeting of the Federal Interagency Committee on EMS that the first round of ET3 applicants included agencies from more than 70 percent of states and representing a diverse range of different service models and community types.