CMS Selects Participants for New Emergency Care Payment Model

CMS announced it selected 205 applications who will participate in the Emergency Triage, Treat, and Transport (ET3) Model, a payment model that ensures beneficiaries’ access to emergency services. 

The five-year payment model will provide enhanced flexibility to ambulance care teams to address emergency healthcare needs of Medicare Fee-for-Service beneficiaries following a 911 call.

Applicants selected to participate in the ET3 Model are Medicare-enrolled ambulance service suppliers or ambulance providers in 36 states and the District of Columbia, the announcement highlighted.

“Most beneficiaries who call 911 with a medical emergency are transported to a hospital emergency department (ED), even when a lower-acuity destination may be more appropriate,” said CMS Administrator Seema Verma, in statement. 

Last February HHS and CMS announced the ET3 model intended to “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 the announcement.

The hope was to encourage more appropriate utilization of services, ensuring patients receive convenient and appropriate treatment by Medicare-enrolled providers and suppliers. The model could save Medicare nearly $560 million per year by transporting beneficiaries to physician offices rather than the hospital ED. 

The Model payment enhances CMS’ efforts in advancing innovative payment structures to shift the healthcare system to one that boosts value by rewarding quality, performance, and innovation.  

“The ET3 model is yet another way CMS is transforming America’s healthcare system to deliver better value and results for patients through innovation,” Verma said. “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 previous time and resources to report to more serious cases.” 

In its current state, Medicare only pays for emergency ground ambulance services when beneficiaries are transported to certain facilities, typically a hospital emergency department. Under the ET3 model, Medicare will pay participating ambulance suppliers to:

• Transport a beneficiary to an alternative destination (primary care office, urgent care clinic)
• Initiate and facilitate treatment in place by a qualified healthcare practitioner in person or via telehealth

Ambulance suppliers and providers may triage Medicare beneficiaries to one of the model’s interventions. This engages healthcare providers across the care continuum by forcing suppliers and providers to partner with alternative destinations and qualified healthcare practitioners to deliver treatment in place. 

CMS noted that they will issue a Notice of Funding Opportunity (NOFO) for up to 40, two-year cooperative agreements, which will be available to state and local governments. The NOFO will fund the implementation of medical triage line integrated with Primary or Secondary Public Safety Answering Point (PSAP) in an eligible region. 

The model will uncover whether the two components work efficiently to improve quality and lower costs by reducing avoidable transport to the ED and unnecessary hospitalizations after the transports. 

CMS expects to announce the final list of ET3 model participants this spring and simultaneously pay for transport to alternative destinations. The agency will also issue the medical triage line NOFO this spring with applications due in the summer and plan to issue the cooperative agreement awards and a two-year period of performance in the fall.   

“The participants in our ET3 Model will be able to deliver care to patients at the right time and place. We congratulate the applicants selected to participate in the model and we look forward to working with them on testing new payments for emergency transport to improve patient care,” Verma concluded.