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News
Release
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U.S. Department of Health and Human Services
FOR IMMEDIATE RELEASE
Thursday, February 14, 2019
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HHS launches innovative
payment model with new treatment and transport options to more
appropriately and effectively meet beneficiaries’ emergency needs
Supporting ambulance triage options aims to allow beneficiaries to
receive care at the right time and place
Today, the U.S. Department of Health and Human Services (HHS), Center
for Medicare and Medicaid Innovation (Innovation Center), which tests
innovative payment and service delivery models to lower costs and improve
the quality of care, announced a new payment model for emergency ambulance
services that aims to allow Medicare Fee-For-Service (FFS) beneficiaries to
receive the most appropriate level of care at the right time and place with
the potential for lower out-of-pocket costs.
“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.
“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.”
The new model, the Emergency Triage, Treat and Transport (ET3) model,
will make it possible for participating ambulance suppliers and providers
to partner with qualified health care practitioners to deliver treatment in
place (either on-the-scene or through telehealth) and with alternative
destination sites (such as primary care doctors’ offices or urgent-care
clinics) to provide care for Medicare beneficiaries following a medical
emergency for which they have accessed 911 services. In doing so, the model
seeks to engage health care providers across the care continuum to more
appropriately and effectively meet beneficiaries’ needs. Additionally, the
model will encourage development of medical triage lines for low-acuity 911
calls in regions where participating ambulance suppliers and providers
operate. The ET3 model will have a five-year performance period, with an
anticipated start date in early 2020.
“The ET3 model is yet another way CMS is transforming America’s
healthcare system to deliver better value and results for patients through
innovation,” said CMS Administrator Seema Verma. “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.”
Currently, Medicare primarily 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. To counter this incentive, the ET3 model will
test two new ambulance payments, while continuing to pay for emergency
transport for a Medicare beneficiary to a hospital ED or other destination
covered under current regulations:
- payment for
treatment in place with a qualified health care practitioner, either
on-the-scene or connected using telehealth; and
- 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).
The ET3 model encourages high-quality provision of care by enabling
participating ambulance suppliers and providers to earn up to a 5% payment
adjustment in later years of the model based on their achievement of key
quality measures. The quality measurement strategy will aim to avoid
adding more burden to participants, including minimizing any new reporting
requirements. Qualified health care practitioners or alternative
destination sites that partner with participating ambulance suppliers and
providers would receive payment as usual under Medicare for any services
rendered.
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.
CMS anticipates releasing a Request for Applications in Summer 2019 to
solicit Medicare-enrolled ambulance suppliers and providers. In Fall
2019, to implement the triage lines for low-acuity 911 calls, CMS
anticipates issuing a Notice of Funding Opportunity 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.
For more information, please visit: https://innovation.cms.gov/initiatives/et3/.
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