CMS Announces New ET3 Model

CMS Announces New ET3 Model

A Valentine from Medicare!

The Centers for Medicare and Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) sent out a Valentine greeting yesterday announcing a new payment pilot program that the ambulance industry will eventually greet with much love.

Using a staged announcement located at a fire house near the US Capitol building, CMS leaders unveiled the new ET3 Model- Emergency Triage, Treat and Transport.

5-Year Model Gives Options

Dubbed a voluntary fire-year payment test model that will only be open to a selected group of EMS agencies, CMS pitched the new program as providing flexibility to the ambulance industry when addressing emergency health care needs of Medicare beneficiaries in the field during a 911 call scenario.

The ET3 model will give chosen ambulance providers and suppliers three options in the 911 situation…

1. Transport the patient to a hospital emergency department or other approved destination as covered under the current rules…or…
2. Transport to an alternative destination (such as a primary care doctor’s office, urgent care or rural health clinic, behavioral health facility)…or…
3. Provide treatment in place using a qualified health care practitioner, either by remaining on the scene to treat or taking treatment advice by remote connection using telehealth technology.

Access to the Most Appropriate Emergency Services

CMS represents ET3 as allowing “…the most appropriate emergency services at the right time and place.” CMS believes that local governments and other stakeholders in the national EMS system will gain authority within the 911 universe to promote spin-off models by establishing medical triage protocols for 911 calls that turn out to be low-acuity situations.

CMS is banking on the fact that there will be a cost-savings demonstrated for Medicare over the five-year period when unnecessary transports are reduced, slicing the number of visits- and dollars paid to reimburse for those visits- to hospital emergency departments. Of course, there is hope that hospital ED overcrowding will eventually be eased, as well, resulting in improved quality of care when beds are freed-up for the most critical patients.

Earlier White Paper

In today’s announcement, CMS credited an earlier U.S. Department of Health and Human Services (HHS) White Paper that studied this issue as being the foundation of ET3. That study predicted a savings for Medicare of $560 million per year if transport was reimbursed for patients to be delivered to a doctor’s office versus a hospital ED.

Broader Access

CMMI claims handing off choices for providers will translate into broader access to various care models for the patient. CMS listed three primary areas that they believe ET3 will demonstrate enhancement to the quality of care.

1. Provide Person-Centered Care- gone will be the pressure of transporting to but one set of options- approved facilities. In theory, ambulance crews and 911 systems can create a triage system that will center on the acuity of the patient’s condition in the field and that will dictate the appropriate final result. CMS is proposing to eventually tie payment for services to performance milestones which will account for quality over quantity.
2. Encourage Appropriate Utilization of Services- health care needs can now be met more effectively in a scenario with ambulance involvement. Systems can think out of the box without the added worry of not being compensated. CMS anticipates that this new funding model will eventually lead to cooperative agreements in the ambulance industry and drive multi-payer adoption of the ET3 model nationwide, not just by Medicare.
3. Increase Efficiency in the EMS System- 911 responders will potentially be freed to more readily respond to and focus on high-acuity cases, such as heart attacks and strokes. CMS is hoping that efficiency will increase as they monitor and share quality metrics throughout the model’s lifespan. Tracking and monitoring will be in place using what CMS dubbed “robust enforcement” to promote greater patient safety and program integrity.

Must Enroll

To participate in ET3, 911 ambulance suppliers and providers will be required to enroll to be reimbursed. CMMI will release a Request for Applications (RFA) this coming summer to solicit Medicare-enrolled ambulance suppliers and providers apply to participate allowing for up to 40 two-year cooperative agreements to be included in the model in one of three phases for a staggered ramp-up approach. The initial phase is slated to start no later than January 2020.

All phases of the program will end at the same time after five years, allowing for only those suppliers and providers selected to participate in the beginning phase, to participate for the entire full five-year duration.

More to Come

As CMMI rolls out the program, more guidance will be issued bringing clarity to how the details of the program will unfold and be implemented. We’ll continue to monitor the developments and update you using this blog space when necessary.