Medicare 911 Patients to Be Triaged by EMS in 5-Year Pilot

The Center for Medicare and Medicaid Innovation (CMMI) on February 14 announced it will launch a 5-year demonstration project that will allow ambulance teams to triage fee-for-service Medicare beneficiaries and take them to a doctor’s office or an urgent care center rather than to an emergency department (ED).

Scheduled to begin in January 2020, the voluntary program will determine whether the new Emergency Triage, Treat, and Transport (ET3) model can safely reduce unnecessary use of EDs by fee-for-service Medicare patients. CMMI, the innovation arm of the Centers for Medicare and Medicaid Services (CMS), is encouraging participants in the program to partner with other payers, including state Medicaid programs, to provide similar interventions to patients in their geographic areas.

Currently, a CMMI fact sheet explains, Medicare pays for ambulance services only when Medicare patients are taken to hospitals, critical access hospitals, skilled nursing facilities, or dialysis centers. In most cases, they’re transported to the ED, even when a lower-acuity-care setting may be more appropriate.

Under the new model, when emergency medical services (EMS) providers arrive at a patient’s residence after a 911 call, they may triage the patient to an ED, a doctor’s office, or an urgent care center. If the patient insists on going to the hospital, the EMS team must honor that person’s wishes. In appropriate cases, the patient may be treated in situ by an EMS professional or through a telehealth consultation.

To ensure that patients are treated well, the program includes quality measurement. “The ET3 model encourages high-quality provision of care by enabling 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,” said a news release from the US Department of Health and Human Services (HHS).

Under the ET3 model, 911 dispatch services, whether operated by a local government or some other entity, will have the opportunity to create government-funded medical triage lines in areas where the model is being tested. When a Medicare beneficiary calls 911 and is connected to a dispatch system that has incorporated a medical triage line, the individual will be screened for eligibility for triage services before the ambulance supplier is contacted.

Phased-in Approach

This summer, Medicare-enrolled ambulance suppliers and providers in certain regions will be asked to apply for participation in the ET3 model. In the fall, to implement triage lines for low-acuity 911 calls, CMS will issue a “notice of funding opportunity” for up to 40 2-year cooperative agreements. This funding will be available to local governments, their designees, or other entities that operate or have authority over 911 dispatches in areas where ambulance suppliers and providers have been selected to participate.

CMMI will phase in the ET3 model in an unspecified number of regions. The agency will conduct up to three rounds of requests for ambulance applications and up to two notices of funding opportunities for dispatch services with staggered start dates. Because the demonstration is limited to 5 years, only the ambulance and dispatch services that enroll during the initial rounds will be able to participate for the full period.

Program Benefits

The goals of the ET3 demonstration, CMMI says, are to ensure the provision of person-centered care based on each patient’s needs, guarantee appropriate utilization of services, and increase the efficiency of the EMS system so that ambulances and EMS professionals can “more readily respond to and focus on high-acuity cases, such as heart attacks and strokes.”

Medicare beneficiaries will have lower copayments when they are triaged to a care setting other than the ED, the agency notes. In addition, the model allows patients to avoid long wait times in the ED and exposure to hospital-acquired conditions.

“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 in the news release.

CMS Administrator Seema Verma commented, “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.”

https://www.medscape.com/viewarticle/909260