A new Medicare payment model being tested on three midstate EMS agencies will offer more options for caring with patients covered under Medicare
The Centers for Medicare & Medicaid Services (CMS), a federal agency that oversees Medicare and Medicaid programs across the country, announced 205 ambulance care organizations that will participate in its new Emergency Triage, Treat and Transport (ET3) Model late last month.
The model drew 210 applicants nationally and CMS chose 205 applicants from 36 states and the District of Columbia.
The local participants include: Harrisburg-based Community LifeTeam EMS; Camp Hill-based Geisinger Emergency Medical Services, formerly known as West Shore Advanced Life Support Services; and Hershey-based Milton S. Hershey Medical Center.
Currently, Medicare only pays ground-based emergency ambulance services when they transport patients to specific types of facilities, with hospital emergency departments being the most common. The new model, which is set to begin this spring and last over a five-year period, will increase the options that participating organizations have with patients, the department wrote in a press release this week.
“For a patient who calls 911 for emergency medical services, the only path for the EMS agency to receive reimbursement for the call is to transport the patient to the emergency department,” said Paul Christophel, executive director at Geisinger EMS. “If a patient can be treated at home and EMS resolves their issue, the EMS agency does not receive reimbursement”
Participants in the model will continue to receive Medicare payments for transporting the Medicare beneficiary to an emergency department, but they would also be covered if they take that patient to a primary care doctor’s office or urgent care clinic.
CMS doesn’t plan to limit the alternative destinations that the EMS agencies can may use, as long as the treatment is provided by Medicare enrolled providers, a CMS spokesperson said in a statement.
The organization could also receive payments for treating the patient at the scene or through telehealth to connect the patient directly to a physician.
Geisinger EMS already treats its patients at home when appropriate, according to Christophel, but the change in model would allow the EMS agency to receive reimbursement for such treatment.
Delivering the Medicare beneficiary to a primary care doctor where fees are cheaper than an emergency room will save both EMS agencies and their Medicare beneficiaries money, said Scott Buchle, program manager at Penn State Health Life Lion EMS.
Patients with less severe conditions like colds and seasonal flu can still be delivered to an emergency department under the current model—conditions that aren’t always covered by insurances and can incur costs on the EMS and its patients, he said.
Through the new model, EMS agencies will be reimbursed for taking Medicare patients to hospitals, physician practices and urgent and walk-in care centers, said Craig Skurcenski, vice president of emergency medicine at UPMC Pinnacle.
“While this new program authorizes payment for alternative care destinations, our primary goal continues to be proper and appropriate care for all patients,” he said. “This will be ensured by patients having a consultation with a licensed provider prior to determining where a patient will be transported.”
Once CMS outlines the rules for the program, EMS agencies will be able to negotiate agreements with local urgent care centers and prepare to leverage technology such as telehealth in their ambulances, Penn State’s Buchle said. Penn State Health’s Life Lion EMS will be looking at bringing Medicare patients to Penn State Health clinics when that patient has a primary care physician within the system.
“In Dauphin and Lebanon counties, the Life Lion units would be allowed to transport to our University Physician Center clinics if the patient has a primary care provider at one of those locations,” he said. “We can also work with our existing telehealth resources within Penn State Health to help provide the care needed.”
Along with the 205 EMS agencies, CMS said it plans to offer funding for up to 40 two-year cooperative agreements between it and local governments or their 911 call centers in regions where a participating agency practices.
The funding would help a local government or call center afford to put a nurse, nurse practitioner or physician assistant in a 911 center to help direct patients to the right care, said Buchle.
The two-year cooperative agreements are a test to see if call centers and the approved EMS agencies can work together to avoid unnecessary transportation even further than what the new model can provide.
“The model will test whether these new options for emergency services will work synergistically to improve quality and lower costs by reducing avoidable transports to the emergency department and unnecessary hospitalizations following those transports,” the department said in a statement.