How a new Medicare ambulance payment model seeks to prevent avoidable ED visits

HHS on Thursday announced the launch of a new voluntary payment model for emergency ambulance services (EMS)—called the Emergency Triage, Treat, and Transport (ET3) model—that would allow Medicare to reimburse first responders for care delivered on-site or via telemedicine, even if patients are not taken to a hospital, HealthLeaders Media reports.

Primer series: How to address avoidable ED utilization

Model details

HHS said the voluntary model, which will have a five-year performance period, is intended to ensure first providers are not taking patients to the emergency department (ED) in instances when such care is not needed. Adam Boehler, director of CMS' Center for Medicare & Medicaid Innovation, said, "A payment system that only pays first responders to take people to the hospital creates the wrong incentive. That leads to unnecessary [ED] visits and hospitalizations and ultimately that harms patients."

HHS Secretary Azar said the model "will … ensur[e] patients get convenient, appropriate treatment in whatever setting makes sense for them."

Under model, EMS providers will continue to receive reimbursements from CMS when they take Medicare beneficiaries to facilities covered under current regulations, which include critical access hospitals, EDs, hospitals, skilled nursing facilities, and dialysis centers. However, EMS providers under the new model also will be reimbursed for:

  • Providing on-site care with a practitioner who is present at or travels to the scene or who delivers care via telemedicine; and
  • Transporting a patient to a primary care provider's office or an urgent care clinic.

HHS in a release said, "Qualified health care practitioners or alternative destination sites that partner with participating ambulance suppliers and providers would receive payment as usual under Medicare for any services rendered." Boehler said Medicare beneficiaries who would like to be transported to the ED can choose to have EMS providers take them to one. Beneficiaries will continue to pay the same copayments for ambulance transportation regardless of where they are taken to receive care.

HHS said providers participating in the model will be eligible to earn up to a 5% payment adjustment based on whether they meet certain quality measures.

CMS plans to release a Request for Applications to participate in the model in mid-2019, aiming to test the model among 30% of Medicare's population beginning as early as 2020. The voluntary model is currently scheduled to run from January 1, 2020, to December 31, 2024.

Further, 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," she said.

Officials say model could save money, time, and lives

Verma said the 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.

Boehler said the model also could save 45 minutes of emergency response time per visit, which across the Medicare population could result in first responders saving 50 million minutes per year. "That will directly translate to into thousands of saved lives," he said (Commins, HealthLeaders Media, 2/14; Wicklund, mHealthIntelligence, 2/14; King, Modern Healthcare, 2/14; Dietsche, MedCity News, 2/14; Minemyer, FierceHealthcare, 2/14; CMS fact sheet, 2/14; HHS release, 2/14). 

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