February 28, 2019
A Medicare pilot program may soon allow ambulance companies to transport seniors to non-hospital facilities for primary or urgent care.
The new payment and service model – called the Emergency Triage, Treat and Transport (ET3) model – comes partly from a mobile health initiative that was first proposed to Medicare officials in 2014.1
Last week, the Centers for Medicare and Medicaid Services (CMS) Innovation Center issued a policy that will allow ambulance suppliers and providers to transport Medicare and Medicaid beneficiaries to facilities other than emergency rooms for care that is not life threatening.
The test program is expected to rollout in early 2020, and will begin a five-year performance period.2
The ET3 model will allow participating ambulance suppliers and providers to respond to emergency calls in more ways.
When participating ambulance providers arrive at a requested destination, they can provide on-the-scene care with a qualified health care practitioner. They can also provide transportation to an alternative health care destination, such as an urgent care clinic or a primary care provider’s office.
Transportation to an emergency room can still be provided, when necessary. The ET3 model, however, seeks to provide more appropriate care at the time of need and discourage unnecessary trips to the emergency room.
In Detroit, where a similar initiative was first proposed, at least 50 percent of ambulance rides to emergency rooms are considered unnecessary, according to reports.1
Original Medicare (Medicare Part A and Part B) currently provides coverage for ambulance rides to the hospital for emergency care, but not to urgent care clinics or doctor’s offices.
When a beneficiary, for example, cuts their hand while slicing a piece of fruit and is unable to get to an urgent care facility on their own, they are left to call for an ambulance ride to the emergency room that can cost thousands of dollars.
Some ambulance providers – such as Greg Beauchemin, CEO of Southfield, Michigan-based Community EMS – say they can make a “house call” for 10 percent of the typical cost to transport a patient to a hospital.1
Medicare out-of-pocket expenses tend to be higher at a hospital than at a clinic or doctor’s office. Receiving non-life-threatening care at a clinic or a doctor’s office could potentially save Medicare beneficiaries a great deal of money in out-of-pocket deductibles and coinsurance.
The program is designed to help improve the quality of beneficiaries’ health care. Many seniors may have trouble getting to the doctor for non-emergency care, which can cause some health issues to worsen.
Medicare Advantage plans (Medicare Part C) have recently begun providing coverage for non-emergency care, and some plans are even partnering with the popular ridesharing business Lyft to do so.
1 Greene, Jay. Medicare pilot program would allow ambulances to take patiens places other than hospitals. (Feb. 24, 2019). Crain’s Detroit Business. Retrieved from www.crainsdetroit.com/health-care/medicare-pilot-program-would-allow-ambulances-take-patients-places-other-hospitals.
2 CMS.gov. HHS launches innovative payment model etc. (Feb. 14, 2019). Retrieved from www.cms.gov/newsroom/press-releases/hhs-launches-innovative-payment-model-new-treatment-and-transport-options-more-appropriately-and.