EMS demo project to use telehealth, e-consults to cut ED visits

The Department of Health and Human Services is testing a new payment model that would promote the use of telehealth and other IT to reduce unnecessary emergency department visits.

The use of technology would just be one part of a plan to reverse current perverse incentives surrounding emergency medical services supplied to Medicare beneficiaries. HHS hopes the new model will enable Medicare beneficiaries who are covered under fee-for-service approaches to get the most appropriate level of care at the right time and place, with the potential to lower costs, including out-of-pocket costs for beneficiaries.

The agency will test the approach as a voluntary demonstration project, with actual testing of the model expected to begin in the fall.

HHS is calling the new model the Emergency Triage, Treat and Transport model (ET3). It will enable participating ambulance suppliers and providers to partner with qualified healthcare practitioners to deliver treatment “in place,” either through on-the-scene care or through telehealth. It also will allow alternative destinations for care, such as primary care physicians’ offices or urgent care clinics.

Historically, EMS services have been reimbursed based solely for transporting a critical care patient to the emergency department. Even if a patient is suffering from a treatable condition in the field, such as low blood glucose, EMS agencies are not reimbursed unless the patient is taken to an accredited emergency department.

Similarly, if a non-emergency department facility is able to treat a patient, the EMS agency will not be reimbursed for care and transport of that patient to that facility. Those policies incentivize utilization of emergency departments nationwide for non-life-threatening conditions, resulting in sometimes unnecessary cost—both to the healthcare system and to those patients who pay out of pocket for this expensive treatment.

The new model would offer alternatives for EMS providers to solely taking beneficiaries for ED treatment—including the use of telehealth or e-consult services with qualified healthcare practitioners, such as physicians, nurse practitioners and physician assistants.

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The technology approaches, as well as the ability to transport patients to non-emergency care venues, could save as much as 45 minutes per patient in average treatment time and could result in $1 billion in savings for the Medicare program.

“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,” says HHS 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.”

In addition, the model will encourage development of medical triage lines for low-acuity 911 calls in regions where participating ambulance suppliers and providers operate. The ET3 model will have a five-year performance period, with an anticipated start date in early 2020.

The model will use a phased approach through multiple application rounds to maximize participation in regions across the country. In an effort to ensure access to model interventions across all individuals in a region, CMS will encourage ET3 model participants to partner with other payers, including state Medicaid agencies.

The National Association of EMS Physicians (NAEMSP), which represents physicians and other professionals in EMS medicine, expressed support for the new model.

“For years, ambulance suppliers and providers have either had to transport non-emergent patients to an already crowded emergency department or forgo reimbursement for valuable life-saving care given in the field,” says NAEMSP president David K. Tan, MD, of the Washington University School of Medicine in St. Louis.

“This model, which promises to include valuable quality measures for care, can potentially transform the way the EMS community provides, and is reimbursed for, care. We look forward to working with HHS, CMS and CMMI as they further develop and deploy this model nationwide.”

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