CMS Launches New Medicare Payment Model

HIGHLIGHTS

  • CMS has introduced a new payment model.
  • This model can improving care coordination for Medicare beneficiaries.

Centers for Medicare & Medicaid Services (CMS) have introduced a new payment model and more than 200 healthcare providers have been selected to participate in it. This payment model uses mHealth and telehealth to improve care for people dialing 911.

CMS has unveiled the Emergency Triage, Treat and Transport (ET3) Model, which has been designed to reimburse care providers who triage 911 calls and transport the caller to an appropriate emergency care service.

The program has been designed to reduce the number of unnecessary 911 transports to hospitals, along with improving care coordination for Medicare beneficiaries who may see the hospital as their primary source of care. It could favor Mobile Integrated Health programs that include Community Paramedicine. Mobile Integrated Health programs use connected health to improve access to care.

CMS Administrator Seema Verma said:

“Most beneficiaries who call 911 with a medical emergency are transported to a hospital emergency department, even when a lower-acuity destination may be more appropriate. The participants in our ET3 Model will be able to deliver care to patients at the right time and place. We congratulate the applicants selected to participate in the Model, and we look forward to working with them on testing new payments for emergency transport to improve patient care.”

Provisions for reimbursement

Traditionally, Medicare pays only for emergency ground ambulance services when members are taken to a hospital or similar emergency care facility. Under the ET3 Model, Medicare will reimburse participants who transport a beneficiary to an alternative destination. Such destination can include a primary care doctor’s office or an urgent care clinic. Medicare will also reimburse participants who initiate and facilitate treatment in place by a qualified health care practitioner. This can be done either in-person on the scene or via telehealth.

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