ED Coding and Reimbursement Alert

Under the five-year model, ambulances can take emergency patients directly to their doctors’ offices.

Emergency departments could end up seeing fewer patients arrive via ambulance, thanks to a CMS model that will pilot a new options for transporting Medicare patients who call 911.

Background: On Feb. 14, CMS released its Emergency Triage, Treat, and Transport Model, also known as ET3. Under the voluntary five-year payment model, ambulance teams will get to decide how to treat patients who call 911. After triaging patients, EMS staff can still take them to the emergency department if they feel it’s the best choice -- or they can instead take them to another location (such as their doctor’s office or an urgent care center), or they can treat the patient at home, either in person or via a telehealth service.

The impetus for the program, CMS said in a Fact Sheet, came from the Department of Health and Human Services’ previous research, which found that Medicare could save $560 million annually by taking patients to other locations besides the ED. “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,” said CMS Administrator Seema Verma during remarks about the program.

CMS plans to carry out the model – which is expected to start next January -- for five years to evaluate it. Participants “will be Medicare-enrolled ambulance service suppliers and hospital-owned ambulance providers,” CMS said in its Fact Sheet about the program. “In addition, to advance regional alignment, local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic areas where ambulance suppliers and providers have been selected to participate in the model will have an opportunity to apply for cooperative agreement funding.”

Looking ahead: The ET3 program could open the door to other changes in treatment locations, if the remarks from HHS Secretary Alex Azar are any indication. “ET3 is a signal to everyone involved in American healthcare that we want to rethink how and where patients are treated,” he said.

Resource: To read more about the model, visit https://www.cms.gov/newsroom/fact-sheets/emergency-triage-treat-and-transport-et3-model.