A new alternative payment model aims to revamp medical transportation, funnelling patients away from the ED and into low-acuity settings.
CMS has selected the five providers that will pilot the Emergency Triage, Treat, and Transport (ET3) Model, an alternative payment model geared toward providing patients with medical transportation to the right kind of medical facility.
The ET3 model aims to provide medical transportation to patients while getting them to the right type of care. The alternative payment model will specifically give ambulance providers and dispatchers more flexibility in getting patients to a provider after a 911 call from a Medicare fee-for-service beneficiary.
Previously, Medicare would only pay for ground ambulance services when patients were transported to certain types of medical facilities, with emergency departments being the most prominent. This created a skewed incentive system that drove more patients into the ED than potentially necessary, according to CMS Administrator Seema Verma.
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“Most beneficiaries who call 911 with a medical emergency are transported to a hospital emergency department, even when a lower-acuity destination may be more appropriate,” Verma explained in a statement. “The participants in our ET3 Model will be able to deliver care to patients at the right time and place. We congratulate the applicants selected to participate in the Model, and we look forward to working with them on testing new payments for emergency transport to improve patient care.”
Specifically, ambulance providers will receive incentive payments for bringing patients to an alternative care setting, including a primary care clinic, a retail health clinic, or an urgent care clinic. They will also receive incentive payments if they administer care on-site, either by an in-person qualified health professional or via telehealth.
CMS will still offer reimbursements to ambulance providers bringing patients to the ED, and patients still have the option to request an ED visit despite the triage recommendation.
This model hinges on effective triage from ambulance providers, the agency emphasized. After coming on the scene of a 911 call, ambulance providers will be in charge of assessing the patient case and triaging that case to the correct course of action – ED transportation, a visit to a low-acuity site, or in-person care.
These first five program participants are already Medicare ambulance providers that operate in 36 states an in the District of Columbia.
CMS also issued a Notice of Funding Opportunity (NOFO) as a part of the program. The NOFO refers to 40 two-year cooperative agreements for state or local governments that have a Primary or Secondary Public Safety Answering Point (PSAP) that answers 911 calls for a certain region. The NOFO will provide funding to put an ambulance triage system into place.
The agency aims to understand whether a PSAP triage system can work in collaboration with the ET3 model, so the NOFO is available to regions where the five ET3 model participants operate.
CMS will issue the NOFO this spring. Also this spring, the agency plans to announce the names of the organizations participating in the ET3 model. The agency plans to notify participants of their acceptance to the program, allowing them time to set up the infrastructure needed to operate on the ET3 model, which will begin this spring.
CMS first unveiled the ET3 model one year ago in partnership with the Center for Medicare and Medicaid Innovation (CMMI). The model has always aimed to offer more diverse medical transportation options for patients, especially those who experience transportation as a social determinant of health.
Limited access to transportation – a problem that afflicted 3.6 million individuals in 2017, according to a report from the American Hospital Association – can have some pretty significant consequences. Patients may opt to go without care, resulting in potentially poor health for the patient and a higher no-show rate for providers.
It can also result in patients superfluously visiting the emergency department, a notoriously expensive place to access care. The patient may call an ambulance when she falls ill, and although she may only need to visit a primary care provider, most ambulances face incentives to drive the patient to the ED. This is the issue CMS is primarily working to address with the ET3 model.
This is one of the first attempts from Medicare to address medical transportation and adequate care access. Both Medicare and Medicaid programs have long had non-emergency medical transportation systems in place, but those systems were limited and relied on a strong patient-provider relationship that facilitates the patient connecting with an NEMT provider.
This latest program from CMS will make it easier for a patient of any health literacy and self-navigation level to benefit from more judicious healthcare utilization. By granting ambulance providers more flexibility in this area, CMS is making it easier for them to get patients to the right type of care at the right time.
Source: PatientEngagement HIT