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CMS Ends ET3 Alternative Payment Model 2 Years Early

Analysis  |  By Eric Wicklund  
   June 28, 2023

The agency says the innovative program that allowed EMS providers to seek alternative care pathways instead of the routine ED transport didn't get enough participants or interventions.

An innovative alternative payment model for emergency transports is ending early due to a lack of participants and interventions.

The Centers for Medicare & Medicaid Services (CMS) has announced it will shut down the Emergency Triage, Treat, and Transport (ET3) Model at the end of this year, two years earlier than planned.

"Current and projected number of interventions are lower than the number anticipated when the Model was designed," the agency said in a notice to participants. "This affects the cost of operating the Model relative to its expected benefits, the ability of CMS to conduct a robust quantitative evaluation of the Model’s impact, and the Model’s ability to achieve the estimated Medicare savings in the Model’s design. For these reasons, CMS has determined that it is not in the public interest to test the Model in Performance Year 4 (Calendar Year 2024) through Performance Year 5 (Calendar Year 2025) and has good cause to unilaterally amend the Agreement to modify its Performance Period." 

Unveiled in 2021, the five-year project was designed to give EMS providers more flexibility in addressing the emergency care needs of their patients. Participants, ranging from EMS and healthcare providers to local governments, were encouraged to identify alternatives to the standard ED transport, such as urgent care centers, physician offices, and telehealth.

In March of 2021, CMS unveiled a list of 184 public and private ambulance providers and suppliers selected to take part in the program, as well as plans to seek $34 million in funding to support the model.

Participating ambulance providers and suppliers are paid by Medicare based on the level of service provided— Basic Life Support (BLS-E) or emergency Advance Life Support, Level 1 (ALS1-E) rate—plus mileage and quality adjustments. The qualified healthcare practitioner is also paid the current Medicare rate if the practitioner can treat the beneficiary in place.

The model had been delayed by one year due to the pandemic, and CMS adjusted the model to include more locations for transports during the public health emergency (PHE).

CMS' decision doesn't affect participation in the model or the ability to bill for ET3 interventions or receive performance-based payments through the end of this year.

"Emergency Medical Services remain an area of focus for CMS, and we believe that the lessons learned from the ET3 Model can aid in the development of potential future initiatives," the agency said.

Eric Wicklund is the associate content manager and senior editor for Innovation, Technology, and Pharma for HealthLeaders.


CMS launched the ET3 Model in 2021 to encourage healthcare providers to look at alternative ways to help patients access care, thus reducing unecessary transports to the ED

Those alternatives could include on-site treatment, telehealth treatment, and transporting patients to an urgent care center, physician's office, or other location.

The agency said the lessons learned from this model will help the agency plot future programs to address emergency medical services.

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