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Medicare’s Option to Avoid the Emergency Department

The Center for Medicare and Medicaid Innovation’s Emergency Triage, Treat, and Transport (ET3) Model is designed to test expanded care destination alternatives to the ED for Medicare beneficiaries who call 911.

Under the ET3 model, 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.

The model will allow beneficiaries to access the most appropriate emergency services at the right time and place. The model will also encourage local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches to promote successful model implementation by establishing a medical triage line for low-acuity 911 calls. As a result, the ET3 model aims to improve quality and lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports.

Goals of the Program

The ET3 Model aims to achieve these goals through three core features:

  1. Quality-Adjusted Payments for EMS Innovations
  1. Support Aligned Regional Markets
  1. Enhanced Monitoring and Enforcement

What This Models Means to Home Care Providers

CMS Administrator Seema Verma said 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.”

This model will likely give patients new flexibility to receive urgent care without the necessity of going to hospital EDs. This model also looks like it opens the door for home care providers of all types to work with ambulance suppliers and providers to prevent hospital admissions/ readmissions and visits to EDs. Now is the time for home care providers to explore alternatives with other providers and suppliers in their communities to avoid unnecessary inconvenience and expense while patients continue to get the care they need.

The ET3 Model will have a five-year performance period beginning this spring. The anticipated start date is now Spring 2020. View the selected applicants list here (PDF)