The Center for Medicare and Medicaid Innovation (CMMI) announced the selected applicants for the Emergency Triage, Treat, and Transport (ET3) Model on February 27, 2020. Whether your organization partners with the selected ambulance companies or not, this model can impact your health system.
The ET3 Model will have a five-year performance period. The start date is anticipated for spring 2020. It’s important to review the list of selected companies now and understand the potential partnership opportunities.
An overview of important areas for your organization to consider follows, including:
- Partnership contract development
- Centers for Medicare & Medicaid Services (CMS) contract review
- Model evaluation
- Notice of funding opportunity (NOFO)
Background
Currently, Medicare regulations only allow payment for emergency ground ambulance services when individuals are transported to:
- Hospitals
- Critical access hospitals (CAHs)
- Skilled nursing facilities (SNFs)
- Dialysis centers
Most beneficiaries who call 911 with a medical emergency are transported to a hospital emergency department, even when a lower-acuity destination may more appropriately meet their needs.
The ET3 Model is a voluntary payment model that will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare fee-for-service (FFS) beneficiaries following a 911 call.
Under the ET3 model, Medicare will pay participating ambulance suppliers and providers to:
- Transport an individual to a hospital emergency department or other destination covered under the regulations
- Transport an individual to an alternative destination partner, such as a primary care doctor’s office or an urgent care clinic
- Provide treatment in place with a qualified health care partner, either on the scene or connected using telehealth
To prepare for changes caused by the new ET3 Model, organizations should consider the following areas.
Partnership Contract Development
Organizations should review their contracts with ambulance organizations in their region to ensure that they’re not negatively impacted by changes caused by the ET3 Model.
Leadership may also want to consider negotiating with ET3 Model participants and community care providers.
CMS Contract Review
It’s essential to carefully review and understand the participation agreement between CMS and the model participant to ensure there’s awareness of the benefits, requirements, and obligations.
Model Evaluation
Assess the impact that ET3 may have on volumes, and explore the feasibility of future participation in the model, especially in light of your overall value-based care strategy.
Notice of Funding Opportunity
CMMI is likely to issue the NOFO for 911 dispatch services that can support the ambulance company’s success in ET3.
Organizations may want to consider reviewing the application process with the ambulance company and providing support to secure funding for the program.
We’re Here to Help
To learn more about ET3 or other value-based models and how they may impact your organization, contact your Moss Adams professionals.