This Could Be Huge


The Center for Medicare and Medicaid Services (CMS), which is the federal agency that sets the rules for EMS reimbursement, among other things, has announced a new program for payment. The big news is that for agencies that choose to participate, there will be reimbursement for some non transports and some transports to facilities other than Emergency Departments.

Emergency Triage, Treat, and Transport (ET3) Model

The Center for Medicare and Medicaid Innovation’s (Innovation Center) Emergency Triage, Treat, and Transport (ET3) Model is 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 ET3 model, the Centers for Medicare & Medicaid Services (CMS) will pay participating ambulance suppliers and providers to 1) transport an individual to a hospital emergency department (ED) or other destination covered under the regulations, 2) transport to an alternative destination (such as a primary care doctor’s office or an urgent care clinic), or 3) provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth.

The goal apparently is to relieve over crowding in Emergency Departments by providing alternative care sites for patients who can’t wait for a primary care provider appointment, but still need care.

Transports to free standing urgent care centers will be reimbursed, as will treat and stay home in some cases. The service is centered around ambulance services providing 9-1-1 responses. The language is a little convoluted, but municipal, hospital operated, and apparently private services providing 9-1-1 response, are eligible. Participation is voluntary and will cover an initial five year period.

The key participants in the ET3 Model will be Medicare-enrolled ambulance service suppliers and hospital-owned ambulance providers. In addition, to advance regional alignment, local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic areas where ambulance suppliers and providers have been selected to participate in the model will have an opportunity to apply for cooperative agreement funding.

There is the bureaucratese version of what I said.

As I said, this could be a huge change in how EMERGENCY ambulance service is provided in the United States.

A couple of areas where I can see change are in treatment of diabetics who have an episode of hypoglycemia. It’s not unusual now for services to treat and then accept a patient refusal for diabetic patients who suffer a hypoglycemic event. The problem with that is that there is no reimbursement mechanism. As a result, the ambulance service has to absorb the cost of response and treatment. Which in it’s turn means that we all pay a bit more for ambulance transport to make up for the services lost.

I can tell you folks, that isn’t cheap. A few years ago the chief of a small (three ambulances) fire based system told me it cost $1,500.00 each time one of his units rolled out the door. That’s whether they transported or not.

Think of that next time someone complains about how expensive an ambulance is.

Under this model, the EMS system can bill for the response and treatment, even without a transport.

Another thing that this will likely allow EMS systems to do is respond to cardiac arrest calls, treat, and terminate resuscitation in the field.

Everyone who has worked in EMS for more than a short period of time has responded to a cardiac arrest and transported a patient that they knew was not going to be resuscitated. It ties up resources in the field and the ED as well endangering the public. Some systems already do field terminations, but don’t get reimbursed for it, so again there is a cost that is absorbed by the rest of the public.

This could tie in with and provide payment for the Community Paramedicine projects that are going on around the country. As of now, they are being funded either by hospitals, grants, or in a few limited cases medical insurance companies. Up until now, CMS has had no mechanism to pay for this type of care.

Also, this could be a career extender for creaky old paramedics that can still do most of the job, but for whom lifting and moving patients is no longer possible.

It will be interesting to see how this works out over the next several years, but it could bring about a sea change in how and where EMS is delivered in the United States.

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After a long career as a field EMS provider, I'm now doing all that back office stuff I used to laugh at. Life is full of ironies, isn't it? I still live in the Northeast corner of the United States, although I hope to change that to another part of the country more in tune with my values and beliefs. I still write about EMS, but I'm adding more and more non EMS subject matter. Thanks for visiting.