For decades we have known that there are consequences to poor transportation options. It is a large contributor as to why many elderly folks miss important doctors appointments. Currently if a Medicare beneficiary were to call 911 they may be faced with the burden of an unnecessary, costly emergency room visit when all they may need is limited treatment in their home, or visit to a primary care doctor. Within the next couple of years, that could change…
On Thursday, February 14th, the Centers for Medicare and Medicaid Services (CMS) released a new model within traditional Medicare that could help beneficiaries enrolled in Medicare avoid unnecessary trips to the Emergency Room.
Currently Medicare only covers ground ambulance transport to hospitals, critical access hospitals, dialysis centers and skilled nursing facilities. The goal of the Emergency Triage, Treat and Transport (ET3) model is to curtail costs and improve quality of care by helping to reduce the number of unnecessary hospital visits a beneficiary might face.
The ET3 model would allow emergency transportation services more flexibility when it comes to how they triage emergencies that may not require a trip to the emergency room. Under this new model, Medicare would reimburse for transport to an urgent care facility, a primary care physician or to deliver treatment in place (this could be either on-the-scene or through telehealth) when an emergency room trip is not warranted.
The model seeks to engage healthcare providers across the spectrum to more appropriately and effectively meet a beneficiaries’ needs. Additionally, the model would encourage development of medical triage lines for low-acuity 911 calls in regions where participating ambulance suppliers and providers operate. CMS will use a phased approach for the model, conducting multiple application rounds to encourage participation in regions nationwide. The organization will also encourage partnerships between ET3 model participants and other payers, including state Medicaid agencies.
CMS plans to release a request for applications during the summer of 2019 to solicit ambulance suppliers and providers who are enrolled in Medicare. Furthermore, in fall 2019, CMS plans to issue a notice of funding opportunity for up to 40 -two-year cooperative agreements, which will be available to local governments, their designees, or other organizations that operate one or more 911 dispatches in participating areas.
At Trusted Senior Specialists we will continue to monitor this model and keep you up to date with the latest news from the Centers for Medicare and Medicaid Services (CMS).