New Payment Model for Ambulance Services: ET3

The Department of Health and Human Services had launched a new payment model for ambulance services that federal officials believe could lower out-of-pocket costs for Medicare fee-for-service beneficiaries. The Emergency Triage, Treat, and Transport Model—ET3—allows ambulance companies to deliver on-the-scene or telehealth services to Medicare FFS patients, and transport them to alternative care venues, such as primary care doctors’ offices or urgent-care clinics. The model will encourage the development of medical triage lines for low-acuity 911 calls in regions where participating ambulance companies operate. The ET3 model will have a five-year performance period, starting in early 2020.

Emergency Triage, Treat, and Transport (ET3) is a voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address the emergency health care needs of Medicare beneficiaries following a 911 call. Under the ET3 model, the Centers for Medicare & Medicaid Services (CMS) will pay to participate in ambulance suppliers and providers to:

  • Transport an individual to a hospital emergency department (ED) or other destination covered under the regulations;
  • Transport to an alternative destination (such as a primary care doctor’s office or an urgent care clinic), or
  • Provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth. ET3 model aims to improve quality and lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports.

As per the Centers for Medicare & Medicaid Services (CMS), the model is designed to prod providers across the care continuum to more appropriately and inexpensively meet beneficiaries’ care needs. Currently, Medicare primarily pays for unscheduled, emergency ambulance services when beneficiaries are transported to a hospital ED. This creates a financial incentive to transport all beneficiaries to the more-expensive ED, even when a cheaper care option is more appropriate. The model will give providers the option of treating Medicare FFS patients at the scene, or using telehealth and transporting them to less-costly care venues when appropriate.

  • The ET3 model will include ambulance payments for treatment with a healthcare provider, either on the scene or using telehealth.
  • The model will also pay for unscheduled, emergency transport to hospital EDs, and alternative destinations, such as urgent care clinics and primary care offices.
  • Federal officials say the model will provide alternatives to transporting patients to more-expensive hospital EDs.

Two New Payment Options

The ET3 model will expand to include two new ambulance payments:

  • Payment for treatment with a healthcare provider, either on-the-scene or using telehealth;
  • Payment for unscheduled, emergency transport of Medicare beneficiaries to alternative destinations, such as 24-hour care clinics, other than destinations covered under current regulations, including hospital EDs.

Currently, Medicare regulations only allow payment for emergency ground ambulance services when individuals are transported to hospitals, critical access hospitals, skilled nursing facilities, and dialysis centers. Most beneficiaries who call 911 with a medical emergency are therefore transported to one of these facilities, and most often to a hospital ED, even when a lower-acuity destination may more appropriately meet an individual’s needs.

Providers and alternative care venues that partner with ambulance companies would receive payment as usual under Medicare for services rendered. The model will be phased in to maximize participation across the country, and CMS will encourage ET3 participants to partner with other payers, including state Medicaid agencies.


Emergency Triage, Treat, and Transport (ET3) Model