CMS Launches New Medicare Payment Model for 911 Triage by Telehealth

More than 200 healthcare providers have been selected to participate in a new payment model from the Centers for Medicare & Medicaid Services that uses mHealth and telehealth to improve care for people dialing 911.

The Emergency Triage, Treat and Transport (ET3) Model, unveiled by CMS in February of 2019, is designed to reimburse care providers who triage 911 calls and transport the caller to an appropriate emergency care service.

The program is designed to reduce the number of unnecessary 911 transports to hospitals and improve care coordination for Medicare beneficiaries who may see the hospital as their primary source of care. It could favor Mobile Integrated Health programs, including Community Paramedicine, that use connected health to improve access to care.

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

Medicare traditionally pays only for emergency ground ambulance services when members are taken to a hospital or similar emergency care facility. Under the ET3 Model, Medicare will reimburse participants who

• Transport a beneficiary to an alternative destination (such as a primary care doctor’s office or an urgent care clinic), or
• Initiate and facilitate treatment in place by a qualified health care practitioner, either in-person on the scene or via telehealth.

The model puts the emphasis on care providers who coordinate care for patients rather than simply taking them to the nearest ED, and offers incentives to health systems who use telehealth and mHealth to partner with ambulance and EMS providers on care coordination.

The 205 applicants selected for the voluntary five-year program are Medicare-enrolled ambulance companies in 36 states and the District of Columbia.

In addition, CMS will soon issue a Notice of Funding Opportunity for as many as 40 two-year programs, run by state and local governments, that coordinate 911 services through a Primary or Secondary Public Answering Point (PSAP) in areas where ambulance providers are participating in the ET3 Model.

“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  when the program was announced in 2019. “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.”