Currently, Medicare only pays for emergency ground ambulance services when beneficiaries are transported to specific types of facilities, most often a hospital emergency department (ED), creating an incentive to transport all beneficiaries to the hospital even when more appropriate alternative treatment options are available. The Emergency Triage, Treat, and Transport (ET3) payment model aims to allow beneficiaries to access the most appropriate emergency services at the right time and place.
As a subcontractor to IMPAQ International, AIR is contributing to the development of a learning system funded by the Centers for Medicare & Medicaid Services (CMS) to support the voluntary, 5-year model designed to give ambulance care teams greater flexibility to address emergency care needs of Medicare fee-for-service beneficiaries following a 911 call. CMS will test two new ambulance payments, while continuing to pay for emergency transport of a Medicare beneficiary to a hospital ED or other destination covered under current Medicare requirements. Under the ET3 model, Medicare will pay participating ambulance suppliers and providers to transport a beneficiary to an alternative destination, such as a primary care doctor’s office or an urgent care clinic, or initiate and facilitate treatment in place by a qualified health care practitioner, either in person on the scene or via telehealth. AIR is responsible for leading the needs assessment, including surveys, focus groups, and in-depth interviews with ET3 model stakeholders as well as annual environmental scans of the published and gray literature. In addition, AIR is providing content expertise in patient and family engagement to inform development of learning system activities and products.