CMMI Launches New Payment Model Offering New Treatment, Transport Options for Ambulances

In an effort to reduce unnecessary emergency department (ED) visits, CMS’ Center for Medicare & Medicaid Innovation (CMMI) has launched a new payment model that will offer more options for ambulance suppliers and providers to bring Medicare beneficiaries to the appropriate site of care.

According to the agency, the voluntary model aims to engage providers across the continuum of care to more appropriately meet the needs of fee-for-service beneficiaries and to encourage the development of medical triage lines for less urgent medical needs.

Currently, Medicare pays for unscheduled ambulance trips to the ED, which the administration says creates an incentive to take all beneficiaries to the hospital even when an alternative treatment setting may be more appropriate.

Under the 5-year Emergency Triage, Treat, and Transport model (ET3)—expected to begin in early 2020—ambulance suppliers and providers will triage beneficiaries based on their presenting needs following a 911 care. The model will still reimburse ambulance providers for transporting beneficiaries to the hospital, but it will also reimburse these providers for transporting a patient to an alternate site of care, such as 24-hour clinics, as well as for partnering with a qualified healthcare practitioner to treat the patient on site or through telemedicine.

Telemedicine has been shown to avoid unnecessary ED visits. A study published in The American Journal of Managed Care^® found that when doctors were reached through telemedicine to decide whether a patient should stay in a skilled nursing facility should be hospitalized, 29% of patients avoided a hospital visit, resulting in $1.55 million in savings in 1 year.

Ambulance suppliers and providers participating in the ET3 model will also be able to earn up to a 5% payment adjustment as progress in the model based on their performance of key quality measures.

“This model will create a new set of initiatives for emergency transport and care, ensuring patients get convenient, appropriate treatment in whatever setting makes sense for them,” said HHS Secretary Alex Azar, in a statement. “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.”

CMMI expects to release a Request for Applications beginning summer 2019 for Medicare-enrolled ambulance suppliers and providers, and once participants are selected, the innovation center will issue a Notice of Funding Opportunity for local governments or other entities that operate or oversee 1 or more 911 dispatches where participating ambulance suppliers and providers reside.

According to CMMI, as part of a multi-payer alignment strategy, ET3 participants will also be encouraged to partner with additional payers, such as state Medicaid agencies, to offer similar interventions for all patients in the area.