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CMS Announces ET3 Payment Model To Reimburse for On-Scene Treatment, Alternative Destinations

Watch the live video of the announcement in Washington, D.C., attended by EMS World.

A historic announcement today from the Centers for Medicare and Medicaid (CMS): EMS providers will finally be reimbursed for patients they do not transport to the hospital.  

The payment model, called Emergency Triage, Treat, and Transport (ET3), dictates that CMS will pay “participating ambulance suppliers and providers to 1) transport an individual to a hospital emergency department (ED) or other destination covered under the regulations, 2) transport to an alternative destination (such as a primary care doctor’s office or an urgent care clinic), or 3) provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth,” according to the press release.

Against a backdrop of ambulances, DC Fire and EMS Chief Gregory Dean opened the event at Station 13 in Washington, D.C., introducing HHS Secretary Alex Azar.  

Azar noted that this announcement of ET3 is one of the first value-based models being rolled out and it is in an area that has been identified to be in obvious need of improvement.  

Azar opened his remarks with a statement that has been obvious to the EMS community for years:  “When you only get paid if you take people to the hospital, guess what happens? You get taken to the hospital!”

“ET3 is a signal to everyone involved in American healthcare that we need to rethink what we are doing.  We need to provide the right care at the right price, in the right setting from the right provider,” Azar said.

Director of CMS' Innovation Center, Center for Medicare and Medicaid Innovation (CMMI) Adam Boehler described how he felt when he learned that EMS only gets paid when they transport patient to a hospital.

“I thought that was a joke.  I had to verify it multiple times,” he said. “What a ridiculous incentive.”

Boehler further stated that this policy has created the wrong incentives and ultimately harms patients.

CMS administrator Seema Verma played a key role in rethinking how HHS pays for value rather than just transport.  She emphasized that the program will not just be for Medicare patients, as CMS will invite state Medicaid programs and other insurance companies to join in adopting the ET3 model.   

“We’ve been tasked with realigning incentives for how we pay for emergency care,” Verma said.

“This is a momentous day, and now we have people who are listening,” said David Prezant, the Chief Medical Officer for the FDNY, who was given time at the podium.  “This is amazing.”

Also included in the audience were invited guests from regional EMS systems as well as dignitaries influential in the local and national arena of EMS payment reform.

Robert Holman, DCFEMS Medical Director, said that the job of EMS has been restricted because of the payment model to “grab and go” to the ED. 

“EMS needs to provide better medical care and help with the overcrowding of EMS and the ED which adversely affects patient care,” Holman said.

Heather Sharar, Executive Director, Ambulance Association of Pennsylvania, was pleased to note that the payment rate is going to be the same whether or not a patient is transported.  

“In Pennsylvania, we just passed a treatment no transport bill, and now we have CMS and ET3, which is great. It will help us cover even more patients,” she said.

Steve Wirth, of Page, Wolfberg and Wirth, LLC, said that this announcement is a whole new way of thinking how EMS is reimbursed.  

“So many people call 911 who don’t need to go to the hospital,” Wirth said. “It is great to finally see a payment model like ET3 that is really going to help the community.”

Others in attendance included payment reform thought leaders Matt Zavadsky, NAEMT President, and Asbel Montes, Senior Vice President of Strategic Initiatives & Innovation at Acadian Ambulance Service, both of whom have a long history of advocating for EMS; Jose Cabanas, Wake County EMS Medical Director and Secretary/Treasurer, NAEMSP; Brent Myers, CMO of ESO Solutions and Immediate Past President, NAEMSP; Glenn Asaeda, Chief Medical Director, FDNY; and Jonathan Washko, Assistant Vice President of the Center of Emergency Medical Services at Northwell Health, also of NAEMT, AIMHI and AAA.

The timeframe for ET3 is detailed on the CMS website: “The Innovation Center anticipates releasing a Request for Applications (RFA) in Summer 2019 to solicit Medicare-enrolled ambulance suppliers and providers. Once participants have been selected and announced, the Innovation Center anticipates issuing a Notice of Funding Opportunity (NOFO) in Fall 2019 for up to 40 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.”


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