CMS unveils participants in new ambulance payment model

By | February 29, 2020

Dive Brief:

  • CMS has unveiled the providers that will participate in its new, voluntary payment model designed to alter reimbursement for emergency services for Medicare fee-for-services members.

  • The agency selected 205 applicants from 36 states and D.C. to participate in the five-year payment program, known as the ET3 model, or emergency triage, treat and transport. The program gives greater latitude to first responders in caring for a beneficiary after a 911 call, CMS said Thursday.  

  • Various units of American Medical Response (AMR), a private-equity backed emergency services provider, applied to participate in a number of states and counties. 

Dive Insight:

The program aims to fix misaligned incentives in emergency services that are provided to Medicare beneficiaries. 

Currently, emergency service providers are only reimbursed when a patient is transported to a hospital, skilled-nursing facility or dialysis center. The provider is not reimbursed for transport to a lower-acuity facility, according to CMS. 

It creates “an incentive to transport all beneficiaries to the hospital even when an alternative treatment option may be more appropriate,” CMS said. Under the new program, provider reimbursement will be expanded to include transportation to a primary care physician or urgent care facility and it will reimburse for responders who provide care in-person on the scene or by telehealth. 

CMS says the changes will spur greater collaboration between emergency responders and other providers beyond the emergency room including urgent care and general practitioners. 

“Importantly, a beneficiary treated by a Model participant can always choose to be brought to an ED if he or she prefers,” CMS said in a statement on Thursday.

The new payment model is set to go into effect in the spring. Applicants will now decide, after being chosen by CMS, if they want to go forward with the five-year voluntary model. 

This is not the only voluntary payment model out of CMS’ innovation center, CMMI, this year, meant to push industry toward paying for value instead of volume.

Earlier this year, CMMI introduced a new, voluntary payment model for primary care services, also for Medicare members and dubbed the Primary Cares Initiative. Essentially, practices would be paid a per member, per month payment to manage the health of a given population. Larger practices could opt in to a similar program but one that carries risk.

Healthcare Dive – Latest News