Emergency Triage, Treat, and Transport (ET3) Model Released

February 2019 ~

CMS has announced a new voluntary payment model called the Emergency Triage, Treat, and Transport (ET3) that, according to the agency, aims to lower out-of-pocket costs for Medicare fee-for-service beneficiaries while assuring appropriate care.

According to the CMS Fact Sheet, the Center for Medicare and Medicaid Innovation’s (Innovation Center) ET3 Model is a voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare beneficiaries following a 911 call.

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.

CMS states 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.

As described by CMS, the ET3 model aims to reduce expenditures and preserve or enhance the quality of care by:

• Providing person-centered care, such that beneficiaries receive the appropriate level of care delivered safely at the right time and place while having greater control of their healthcare through the availability of more options
• Encouraging appropriate utilization of services to meet health care needs effectively.
• Increasing efficiency in the EMS system to more readily respond to and focus on high-acuity cases, such as heart attacks and strokes.

The agency says the ET3 model will achieve these goals by implementing three core features:

1. Quality-Adjusted Payments for EMS Innovations
   • Provide new payment options for transport and treatment in place of calling 911
   • Tie payment to performance milestones to hold participants accountable for quality.

2. Support Aligned Regional Markets
   • Make cooperative agreements available to local governments
   • Focus funding

3. Enhanced Monitoring and Enforcement
   • Build accountability through monitoring of specific quality metrics and adverse events
   • Include robust enforcement to ensure patient safety and program integrity.

The ET3 Model will have a five-year performance period. The anticipated start date is January 2020. The performance period for all participants, regardless of start date, will end at the same time; thus, according to CMS, only applicants selected through the first RFA will participate for the full five years.

For more information on the ET3 Model, refer to CMS’ Innovation Center ET3 page.

Source(s): CMS Fact Sheet; HealthcareDIVE;