- CMS is launching a new payment model for ambulance services that aims to lower out-of-pocket costs for Medicare fee-for-service beneficiaries while assuring appropriate care.
- The new model — Emergency Triage, Treatment and Transport (ET3) — will pay first responders for care provided onsite via EMS crews or telehealth, as well as unscheduled emergency transport to hospital emergency rooms and alternative sites such as primary care offices and urgent care clinics.
- The model also encourages the creation of medical triage lines for low-acuity 911 calls in areas where participating ambulance suppliers and providers operate. The five-year demonstration project is expected to kick off next January.
The new ET3 model reflects the federal government's ongoing push for value-based care. Adam Boehler, head of the CMS payment model testing and innovation center, told attendees at HIMSS19 to expect more payment models, including some for kidney care and other to spur transparency initiatives.
Participating ambulance suppliers and providers with ambulance services can earn up to a 5% payment adjustment in the later years of the demonstration by meeting key quality objectives. HHS said it will seek to minimize reporting burden associated with the quality measures. Physicians and alternative destination sites that partner with participating ambulance services will be paid as usual by Medicare.
Also in its favor: The model doesn't appear to carry any downside risk, which could increase participation. A recent Government Accountability Office report found just 39% of hospitals participating in the second iteration of the Bundled Payments for Care Improvement model stayed in the program after moving into the phase where failing to cut costs while providing high-quality care brings financial penalties.
CMS plans to roll out the ET3 model in a series of application rounds across the country. Participating ambulance suppliers will be encouraged to partner with other payers besides Medicare, including state Medicaid agencies.
The model could help reduce unnecessary and costly ER visits. Medicare primarily pays for unscheduled ambulance rides now when they transport beneficiaries to a hospital ER. With ET3, ambulance suppliers will be incentivized to take patients to alternative sites or connect with a telehealth practitioner when hospital-based emergency services aren't required.
"This model will help make how we pay for care more patient-centric by supporting care in more appropriate settings while saving emergency medical services providers precious time and resources to respond to more serious cases," CMS Administrator Seema Verma said in a statement.
Eric Schneider, senior vice president for policy and research at The Commonwealth Fund, said such change would take time and depend on a number of circumstances, however.
"Changing the current 911 and EMS transport rules could result in better care for patients, but these are complex systems so changes could have many consequences (intended and unintended)," he told Healthcare Dive via email.
Schneider believes the phased rollout will speed understanding of the model's effectiveness. "Well-designed local evaluations coordinated through a central evaluator will be needed to produce solid evidence on the effects on access to emergency services, the capability of primary care clinics to support people diverted from emergency rooms, the quality and safety of care for beneficiaries, and the cost implications," he said.