Starting early next year, the U.S. Department of Health & Human Services (HHS) will begin a trial program with new financial incentives, including telemedicine reimbursement, to encourage emergency medical services (EMS) to use telemedicine and transport Medicare and Medicaid patients to clinics other than the emergency room. Currently, only visits to hospitals, skilled nursing facilities, and dialysis centers are reimbursed, even when a lower-acuity destination may be more appropriate. The goal is two-fold: to promote a value-based payment system and to reduce unnecessary ER visits and hospitalizations.
The voluntary payment model, called Emergency Triage, Treat, and Transport (ET3), will run for five years. The same reimbursement will be offered regardless of whether an ambulance transports a patient to an emergency room or to an alternative site, such as an urgent-care clinic or primary care doctor’s office. EMS will also be reimbursed if they partner with a qualified healthcare provider to deliver treatment on the scene or via telemedicine. In addition, funding will be made available to facilitate the formation of medical triage lines for low-acuity 911 calls.
Previously, the HHS, in conjunction with the U.S. Department of Transportation, found that Medicare could save over half a billion dollars each year by transporting patients to doctors’ offices instead of emergency rooms—and this doesn’t even take into account avoided inpatient hospitalizations and opportunities for treating at the site of the emergency. Thus, through ET3, the HHS sees a significant opportunity for cost savings and a more appropriate level of care provided for medical 911 calls.
Medicare-enrolled ambulance service suppliers and hospital-owned ambulance providers are encouraged to respond to the Request for Applications (RFA) starting in late summer 2019 to become a participant in the ET3 Model. Local governments and entities that oversee 911 dispatches in a region with at least one ambulance provider/supplier per the requirements in the Notice of Funding Opportunity (NOFO), to be issued in fall 2019, are eligible to apply for selection as a Model awardee to create a medical triage line.
To read a summary of the ET3 model, visit Modern Healthcare here.
To read more about the ET3 model and telemedicine reimbursement, visit the Centers for Medicare & Medicaid Services’ website, CMS.gov, here.