New Payment Model for Ambulance Services: ET3

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New Payment Model for Ambulance Services ET3

• The Department of Health and Human Services had
  launched a new payment model for ambulance
  services that federal officials believe could
  lower out-of-pocket costs for Medicare
  fee-for-service beneficiaries. The Emergency
  Triage, Treat, and Transport ModelET3allows
  ambulance companies to deliver on-the-scene or
  telehealth services to Medicare FFS patients, and
  transport them to alternative care venues, such
  as primary care doctors offices or urgent-care
  clinics. The model will encourage the development
  of medical triage lines for low-acuity 911 calls
  in regions where participating ambulance
  companies operate. The ET3 model will have a
  five-year performance period, starting in early
  2020.
• Emergency Triage, Treat, and Transport (ET3) is a
  voluntary, five-year payment model that will
  provide greater flexibility to ambulance care
  teams to address the emergency health care needs
  of Medicare beneficiaries following a 911 call.
  Under the ET3 model, the Centers for Medicare
  Medicaid Services (CMS) will pay to participate
  in ambulance suppliers and providers to
• Transport an individual to a hospital emergency
  department (ED) or other destination covered
  under the regulations
• Transport to an alternative destination (such as
  a primary care doctors office or an urgent care
  clinic), or

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New Payment Model for Ambulance Services ET3

• Provide treatment in place with a qualified
  health care practitioner, either on the scene or
  connected using telehealth. ET3 model aims to
  improve quality and lower costs by reducing
  avoidable transports to the ED and unnecessary
  hospitalizations following those transports.
•  As per the Centers for Medicare Medicaid
  Services (CMS), the model is designed to prod
  providers across the care continuum to more
  appropriately and inexpensively meet
  beneficiaries care needs. Currently, Medicare
  primarily pays for unscheduled, emergency
  ambulance services when beneficiaries are
  transported to a hospital ED. This creates a
  financial incentive to transport all
  beneficiaries to the more-expensive ED, even when
  a cheaper care option is more appropriate. The
  model will give providers the option of treating
  Medicare FFS patients at the scene, or using
  telehealth and transporting them to less-costly
  care venues when appropriate.
• The ET3 model will include ambulance payments for
  treatment with a healthcare provider, either on
  the scene or using telehealth.
• The model will also pay for unscheduled,
  emergency transport to hospital EDs, and
  alternative destinations, such as urgent care
  clinics and primary care offices.
• Federal officials say the model will provide
  alternatives to transporting patients to
  more-expensive hospital EDs.

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New Payment Model for Ambulance Services ET3

• Two New Payment Options
• The ET3 model will expand to include two new
  ambulance payments
• Payment for treatment with a healthcare provider,
  either on-the-scene or using telehealth
• Payment for unscheduled, emergency transport of
  Medicare beneficiaries to alternative
  destinations, such as 24-hour care clinics, other
  than destinations covered under current
  regulations, including hospital EDs.
• 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. Most
  beneficiaries who call 911 with a medical
  emergency are therefore transported to one of
  these facilities, and most often to a hospital
  ED, even when a lower-acuity destination may more
  appropriately meet an individuals needs.
• Providers and alternative care venues that
  partner with ambulance companies would receive
  payment as usual under Medicare for services
  rendered.

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New Payment Model for Ambulance Services ET3
The model will be phased in to maximize
participation across the country, and CMS will
encourage ET3 participants to partner with other
payers, including state Medicaid
agencies. Reference Emergency Triage, Treat,
and Transport (ET3) Model