Currently, Medicare regulations only allow payment for emergency ground ambulance services when individuals are transported to hospitals, critical access hospitals, skilled nursing facilities, and dialysis centers. This creates the incentive to bring beneficiaries to high acuity and high cost settings even when a lower acuity lower cost setting may more appropriately meet an individual’s needs.
Center for Medicare and Medicaid Innovation (Innovation Center) https://innovation.cms.gov has announced a new payment model for emergency ambulance services called “Emergency Triage, Treat, and Transport” (ET3) https://innovation.cms.gov/initiatives/et3.
The five year payment model will provide greater flexibility to ambulance care teams to address emergency healthcare needs of Medicare beneficiaries following a 911 call for emergency ambulance services. This will allow Medicare Fee-For-Services (FFS) beneficiaries to receive the most appropriate level of care at the right time and place with the potential to lower out of pocket costs.
A White Paper by HHS and the Department of Transportation found that Medicare could save $560 million per year by transporting individuals to doctors’ offices rather than a hospital emergency department.
Under the ET3 model, CMS would pay participating ambulance suppliers and providers to transport an individual to a hospital emergency department. However, if the situation warrants it, then the patient could be delivered to another alternative destination such as a primary care doctor’s office, an urgent care clinic, or to a qualified healthcare practitioner either on the scene or connected using telehealth.
The ET3 model will test two new ambulance payments while continuing to pay for emergency transport for a Medicare beneficiary to a hospital emergency department or other destinations covered under current regulations
CMS anticipates releasing a Request for Applications (RFA) this summer to solicit Medicare enrolled ambulance suppliers and providers and in fall 2019, CMS is going to implement the triage lines for low acuity 911 calls.