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HHS' new payment model recognizes the value of community paramedicine. Here's what it means for population health providers.

February 21, 2019

    Last week, HHS' Center for Medicare and Medicaid Innovation announced the launch of a new voluntary payment model for emergency ambulance services (EMS), called the Emergency Triage, Treat, and Transport (ET3) model. ET3 will allow Medicare to reimburse first responders for care delivered on-site or via telemedicine, even if patients are not taken to a hospital.

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    ET3 is a welcomed change for population health leaders and EMS providers alike. Today's fee-for-service reimbursement model incentivizes transports to hospital EDs, even when it's not the appropriate source of care. In fact, an estimated 17% of EMS transports are unnecessary. ET3's treatment-without-transport and alternate destination transport options attempt to decrease unnecessary ED use, improve patient outcomes, and generate cost savings. This new model will enable potential reimbursement for community paramedicine programs, which have been expanding across the nation in the last few years.

    While this model serves as a much-needed influx of funds for sustainable programs, providers cannot simply expect to plug-and-play ET3 into current care models and expect big wins.

    New reimbursement overcomes community paramedicine's greatest challenge: sustainable funding

    Historically, one of the major challenges in standing up and sustaining community paramedicine programs was funding. While some Medicaid (e.g., Minnesota) and commercial reimbursement already exists, most programs rely on grant funding and/or self-fund the program as a cost reduction strategy for risk-based populations.

    HHS' hope is that the reimbursement model will extend beyond Medicare fee-for-service patients and catalyze conversations about reimbursement with other payers. According to CMS Administrator Seema Verma, the model "isn't just limited to Medicare. [CMS is] also going to invite state Medicaid programs and other insurance companies to join us in adopting this model."

    Programs generally demonstrate strong results but evidence lacks academic rigor

    There is a wealth of case study examples of community paramedicine programs. Successful programs impact acute utilization, patient access and outcomes, and stakeholder satisfaction. However, few of these studies are academically rigorous (e.g., randomized controlled trials). Consequently, different implementation models demonstrate a variety of impacts on key performance indicators. For instance, programs calculated cost savings ranging from insignificant to $39K per person and ED reduction ranging from insignificant to 75% decrease. 

    Verma said the ET3 model could generate $1 billion in savings for the U.S. health system by helping Medicare beneficiaries avoid unnecessary ED care. According to FierceHealthcare, about 19% of Medicare fee-for-service beneficiaries could avoid ED visits and receive care at home or another facility for a lower cost. But the impact at your organization highly depends on the target population, main services, and staffing.

    While all community paramedicine programs are designed to prevent recurring escalation of care, these models don't all look the same

    Given limited funding, these programs started by identifying gaps in existing community health services to determine which services and what staff the community paramedicine program should include. Thus, existing programs across a range of models have focused on areas that would maximally impact cost of care and utilization in their market.

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