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Emergency Medical Transportation APM to Drive Patient Care Access

HHS and CMMI have created a payment model to triage emergency medical transportation and streamline patient care access.

emergency medical transportation

Source: Thinkstock

By Sara Heath

- The Department of Health & Human Services, alongside the Centers for Medicare and Medicaid Innovation (CMMI) have launched the Emergency Triage, Treat, and Transport (ET3) program. The advanced payment model (APM) will help drive patient care access to the right provider, at the right time, for a better cost.

“This model will create a new set of incentives for emergency transport and care, ensuring patients get convenient, appropriate treatment in whatever setting makes sense for them,” HHS Secretary Alex Azar said in a public statement. “Today’s announcement shows that we can radically rethink the incentives around care delivery even in one of the trickiest parts of our system. A value-based healthcare system will help deliver each patient the right care, at the right price, in the right setting, from the right provider.”

Healthcare providers and ambulance companies can now partner to bring patients to appropriate care sites depending on patient needs.

Too often, a patient will call 911 because she has no other transportation option to get to the doctor. Transportation is a key social determinant of health, and hindered nearly 3.7 million patients from care access in 2017, according to industry data.

Traditionally, patients who call 911 for an ambulance ride end up in the emergency department, a notoriously expensive care site. This is because Medicare currently only pays ambulance providers when they transport a patient to the ED, even if the patient was not experiencing high-acuity needs.

This provided an incentive for ambulance providers to take patients to the ED only, and created significant financial inefficiency.

This new APM will allow ambulance drivers to take patients to other care sites, such as clinics or primary care providers, when those facilities are appropriate for a patient’s symptoms. These care avenues will be made possible by an alternative payment model for patients receiving care at these sites.

Ambulance providers may also treat patients on the spot or connect patients with providers using telehealth services. ET3 also creates a separate payment option for patients receiving on-site or telehealth care.

Patients experiencing life-threatening emergencies will still be transported to an ED, HHS and CMMI confirmed.

“The ET3 model is yet another way CMS is transforming America’s healthcare system to deliver better value and results for patients through innovation,” CMS Administrator Seema Verma said in a statement. “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.”

This program also aims to make the 911 call process simpler and more efficient, HHS and CMMI reported. By creating triage lines, 911 call dispatchers can more easily connect patients with the type of need that will be most appropriate for them.

Ultimately, these programs should cut unnecessarily spending. Connecting patients with the correct acuity of care – not higher acuity – will limit the amount of wasted healthcare spend. It will also ensure patients receive the correct type of care and ideally lower their out-of-pocket spending, especially as ED billing is getting special industry and public scrutiny.

CMS will begin a program application process in summer of 2019. In the fall of 2019, the agency will accept funding applications for setting up the 911 triage lines.

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