The Trump administration has said that only allowing Medicare to pay for patients to be taken by ambulance to an emergency room “hinders creation of a value-based system.” (Photo: Shutterstock)
The department of Health and Human Services is planning a test—allowing ambulances to take patients to destinations other than hospitals to try to cut down on unnecessary hospital trips.
Modern Healthcare reports that the Center for Medicare and Medicaid Innovation plans to let patients be taken to urgent care centers or doctors' offices by ambulance suppliers and providers—or even to allow the use of telemedicine—and still get paid by Medicare. According to the report, the model would apply to Medicare fee-for-service beneficiaries.
The Trump administration has said that only allowing Medicare to pay for patients to be taken by ambulance to an emergency room “hinders creation of a value-based system.”
“A payment system that only pays first responders to take people to the hospital creates the wrong incentive,” Adam Boehler, director of CMMI, is quoted in the report saying at an event at a Washington, D.C., fire station. Boehler adds, “That leads to unnecessary ER visits and hospitalizations and ultimately that harms patients.”
Under the new system to be tested—called the Emergency Triage, Treat and Transport model, or ET3, which will run for five years and is expected to start in early 2020—ambulances would be paid the same whether they took a patient to an emergency room or to an alternative site such as a 24-hour urgent care clinic.
As another alternative, the report adds, the system “would also pay an ambulance supplier and provider for partnering with a qualified healthcare practitioner to deliver treatment either on the scene of a medical emergency or via telehealth.”
In addition, the model is intended to encourage the development of medical “triage lines” for 911 calls in areas in which a participating ambulance supplier operates.
There's also a financial incentive farther down the road for ambulances to meet quality measures: a payment adjustment of up to 5 percent in the later years of the model.
HHS intends to solicit applications to participate in the model by this summer from ambulance suppliers and providers enrolled in Medicare.
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Marlene Satter
Marlene Y. Satter has worked in and written about the financial industry for decades.
