HHS will test paying ambulance providers for trips to alternative sites, telemedicine

HHS will test allowing ambulance suppliers and providers to transport Medicare and Medicaid patients to areas besides the emergency room, such as a doctor’s office or urgent-care facility, or use telemedicine, in a bid to reduce unnecessary trips to the hospital.

The Center for Medicare and Medicaid Innovation will pilot a new payment model that would apply to Medicare fee-for-service beneficiaries.

Currently Medicare pays for an ambulance to the emergency room, which Trump administration officials say hinders creation of a value-based system.

“ET3 is a signal to everyone involved that we want to rethink how and where patients are treated,” HHS Secretary Alex Azar said.

The five-year voluntary payment model—called the Emergency Triage, Treat and Transport model, or ET3—is expected to start in early 2020. An ambulance provider would still get paid for transporting a patient to an emergency room. However, the provider would get the same reimbursement if they transport the patient to an alternative site such as a 24-hour urgent-care clinic.

The model would also pay an ambulance supplier and provider for partnering with a qualified healthcare practitioner to deliver treatment either on the scene of a medical emergency or via telehealth. Any participating ambulance supplier or provider could earn up to a 5% payment adjustment in later years of the model if they meet certain quality measures.

The model will also encourage development of medical “triage lines” for 911 calls in regions where a participating ambulance supplier operates, HHS said.

CMS Administrator Seema Verma said that the model “isn’t just limited to Medicare. We are also going to invite state Medicaid programs and other insurance companies to join us in adopting this model.”

HHS will vet applications to participate in the model by summer 2019.