CMS launches new model for paying ambulance crews—even if they don't transport to the ER

Ambulance
CMS has unveiled a new payment model that would pay EMS providers who transport patients to urgent or primary care, or who provide care onsite. (katifcam/iStock/Getty Images Plus/Getty Images)

The Trump administration is launching a new model that would pay first responders even if they opt not to take a patient to the hospital. 

The Emergency Triage, Treat and Transport (ET3) model will pay first responders when they transport patients by ambulance to urgent care or their primary care provider, and will also cover care provided by EMS onsite, either in-person or through telehealth. 

Department of Health and Human Services Secretary Alex Azar said at a press conference Thursday afternoon that the goal of the model is to end the incentives for first responders to transport patients to the emergency room, where care is more costly and can take longer. 

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And in the bigger picture, the model is a “signal to everyone involved” that it’s possible to rethink where patients traditionally receive care, Azar said. 

“Together, this effort is going to save lives and it’s going to improve the quality of care in our system,” he said. 

RELATED: HHS sets 3 new priorities for new physician-focused payment models 

Adam Boehler, director of the Center for Medicare & Medicaid Innovation who’s shepherding the model, said at the conference that Medicare beneficiaries' copayments for ambulance transport will remain the same regardless of where they’re taken, but they will see savings in avoiding costly ER care. 

Centers for Medicare & Medicaid Services Administrator Seema Verma said at the press conference that the model could save the healthcare system $1 billion in avoidable ED costs, as 19% of Medicare fee-for-service beneficiaries could be treated at home or in another, cheaper facility for their emergency needs. 

Boehler said the model could also save 45 minutes of emergency response time for a visit, which expanded across the Medicare population alone would save first responders 50 million minutes per year. And in many emergency situations—such as for patients having a heart attack or stroke—every minute counts, he said.

“That will directly translate to into thousands of saved lives,” Boehler said.

Patients who want to be transported to the ER will still have that option, too, he said.

RELATED: Spending on emergency care continues to grow even as use remains flat 

Boehler said that EMS providers that choose to participate in the model will have options in how they wish to structure the on-site element.  

Some may choose a telehealth-heavy model, where a doctor or other advanced practice clinician provides care via remote monitoring, and some may instead choose to have a physician or nurse practitioner who travels to the emergency scene. 

CMS is hoping that Medicaid and private payers also take an interest in the voluntary model, Verma said. Boehler said CMMI is looking to test the ET3 in about 30% of the Medicare population, beginning as early as 2020. 

The demonstration would last for five years, according to a fact sheet from CMS. CMS will begin accepting applications for Medicare-participating ambulance services and EMS providers this summer.

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