HHS, CMS Innovation Center Announce New Payment Model to Improve Medicare Beneficiaries’ Emergency Needs

The US Department of Health and Human Services (HHS) and Center for Medicare & Medicaid Innovation Center, “which tests innovative payment and service delivery models to lower costs and improve the quality of care,” launched a new payment model for emergency ambulance services to improve care quality and potentially lower costs.

The new model is intended to allow Medicare Fee-For-Service beneficiaries to receive the highest quality of care in the most appropriate settings and locations, utilizing telehealth, while lowering out-of-pocket costs as much as possible.

“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,” said HHS Secretary Alex Azar in the press release. “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 health care system will help deliver each patient the right care, at the right price, in the right setting, from the right provider.”

The Emergency Triage, Treat and Transport (ET3) model, as it has been titled, will enable ambulance suppliers and providers to collaborate with qualified health care practitioners to assess and deliver treatment either on scene, via telehealth, doctor’s offices, or urgent care clinics for Medicare beneficiaries after a medical emergency for with they have accessed 911 services.

According to the press release, Medicare currently pays for “unscheduled, emergency ground ambulance services when beneficiaries are transported to a hospital emergency department (ED), creating an incentive to transport all beneficiaries to the hospital even when an alternative treatment option may be more appropriate.”

The ET3 model will test two new ambulance payments: (1) payment for treatment in place with a qualified health care practitioner, either on-the-scene or connected using telehealth; and (2) payment for unscheduled, emergency transport of Medicare beneficiaries to alternative destinations (such as 24-hour care clinics) other than destinations covered under current regulations (such as hospital EDs), according to the press release.

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

The press release also states, “The model will use a phased approach through multiple application rounds to maximize participation in regions across the country. In an effort to ensure access to model interventions across all individuals in a region, CMS will encourage ET3 model participants to partner with other payers, including state Medicaid agencies.—Edan Stanley