CMS Issues New Payment Model for Emergency Services
- The Centers for Medicare and Medicaid Services (“CMS”) announced a new payment model for ambulance services and related treatment that provides reimbursement even when patients are not taken to a hospital’s emergency department (“ED”).
- The new model, the Emergency Triage, Treat and Transport (“ET3”) model, will make it possible for ambulance providers to partner with qualified health care practitioners to deliver treatment in place (either on-the-scene or through telehealth) and with alternative destination sites (such as primary care doctors’ offices or urgent-care clinics) to provide care for Medicare beneficiaries following a medical emergency for which they have accessed 911 services.
- “This model will create a new set of incentives for emergency transport and care, ensuring patients get convenient, appropriate treatment in whatever setting makes sense for them,” said Health and Human Services’ Secretary Alex Azar. “Today’s announcement shows that we can radically rethink the incentives around care delivery even in one of the trickiest parts of our system.”
- Currently, Medicare primarily pays for unscheduled, emergency ground ambulance services when beneficiaries are transported to an ED, creating an incentive to transport all beneficiaries to the hospital even when an alternative treatment option may be more appropriate.
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James (Jim) A. Dietz is a Member at FBT who provides an array of legal services to hospitals, physicians, long-term care providers, diagnostic facilities, and others across the spectrum of patient care.