ET3 Phone 911: Developments in Ambulance Services Delivery and Payment

Summary

On February 14, 2019, the U.S. Department of Health and Human Services (“HHS”) Center for Medicare and Medicaid Innovation (“CMMI”) launched a new five-year payment model for emergency ambulance services named the Emergency Triage, Treat and Transport Model (“ET3”). ET3 will enable participating ambulance providers and suppliers (“Ambulance Providers”) to partner with qualified health care practitioners to deliver treatment “in place” and at sites other than the traditional hospital emergency department when a Medicare beneficiary calls for emergency assistance through a call to 911. ET3 will be phased in through multiple application rounds to maximize participation across the U.S. ET3 meets the CMMI goal of testing innovative payment and service delivery models to lower health care costs and improve the quality of care for beneficiaries.

Background and Details

Currently, Medicare primarily pays for emergency ground ambulance transportation to a hospital emergency department (“ED”), even though there may be more appropriate, less costly care options than treatment in the ED. The ET3 model will test two new ambulance payments:

Payment for treatment “in place” with a qualified health care practitioner, either on the scene or connected by a telehealth link; and
Payment for unscheduled, emergency transport to alternative destinations such as 24-hour care clinics.

ET3 will encourage development of medical triage lines for low-acuity 911 calls in regions where participating Ambulance Providers operate. In the later years of the model, participating Ambulance Providers will be eligible to earn a five percent payment adjustment for meeting certain quality metrics, with a minimum of new reporting requirements. Qualified health care providers and alternative destination sites that partner with Ambulance Providers will receive payment as usual under Medicare for services rendered.

Practical Takeaways

This summer, CMS is expected to release a Request for Applications to solicit participation in ET3 by Ambulance Providers. Ambulance Providers should be on the lookout for applications and can learn more here.
In Fall, 2019, to implement the triage lines for low-acuity 911 calls, CMS also will issue a Notice for Funding Opportunity for a limited number of two-year cooperative agreements available to local governments or other entities that operate or have authority over 911 dispatch in regions where Ambulance Providers have been selected to participate.
Further details can be found here.

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