New ambulance payment model will reimburse for on-site treatment, use of telehealth

A new payment model for emergency ambulance services will allow participating ambulance suppliers to partner with physicians and health systems to treat Medicare patients on the scene or through telehealth.

The five-year model allows these ambulance suppliers and providers to earn up to a 5 percent payment adjustment in later years of the model based on their achievement of key quality measures. The quality measurement strategy will aim to minimize new reporting requirements. 

Providers, including those at alternative destination sites that partner with participating ambulance suppliers, would receive payment as usual under Medicare for any services rendered.

The model is testing two new payments: for treatment in place with a qualified healthcare practitioner, either on the scene or connected using telehealth; and for emergency transport to an alternative destination, such as to a 24-hour care clinic.

Also, under the model, Medicare beneficiaries can follow up on their 911 medical emergency at alternative destination sites, such as at their primary care doctor's office or urgent-care clinic.

WHY THIS MATTERS

The new emergency triage, treat and transport (ET3) model from the Centers for Medicare and Medicaid Innovation, aims for the most appropriate level of care with the potential for lower out-of-pocket costs.

It is expected to encourage the development of medical triage lines for low-acuity 911 calls in regions where participating ambulance suppliers and providers operate. Starting this fall, the Centers for Medicare and Medicaid Services will implement a notice of funding opportunity for the development of these triage lines.

This is for a limited number of two-year cooperative agreements, available to local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic locations where ambulance suppliers and providers have been selected to participate.

THE TREND

Currently, Medicare primarily pays for unscheduled, emergency ground ambulance services when beneficiaries are transported to a hospital emergency department, creating an incentive to transport all beneficiaries to the hospital even when an alternative treatment option is available.

WHAT ELSE YOU NEED TO KNOW

The ET3 model will have a five-year performance period, with an anticipated start date in early 2020.

It 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 is encouraging ET3 model participants to partner with other payers, including state Medicaid agencies.

CMS anticipates releasing a request for applications this summer to solicit Medicare-enrolled ambulance suppliers and providers. 

ON THE RECORD

"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," said CMS Administrator Seema Verma.

"Today's announcement shows that we can radically rethink the incentives around care delivery even in one of the trickiest parts of our system, said HHS Secretary Alex Azar.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com