Newsletters

POSTED: June 16th, 2023
POSTED IN: 2023 Quarter 2, EM Pulse - The Official Newsletter of MOCEP,

Written by Melissa Kroll, MD, MOCEP Board Member

The Emergency Triage, Treat, and Transport (ET3) Model is a voluntary, five-year payment pilot model that was created by Center for Medicare and Medicaid Innovation (CMMI) with the aim of increasing the flexibility and efficiency of prehospital systems. There were three components of the original model, which allowed for 1) triage from dispatch centers to direct care to appropriate locations, 2) treatment on scene in collaboration with a telehealth provider, and 3) the ability to transport to alternative destinations. While the triage from dispatch centers was removed from the model, the ability to perform telehealth in the home and transport to alternative destinations has been in place for some agencies as early as 2020. Perhaps the most ground-breaking aspect of ET3 is the ability of Emergency Medical Services (EMS) systems to be reimbursed for the healthcare provided. Historically, EMS systems were seen as a transport service rather than an integral piece of the healthcare system. In Missouri, this association is so strong that to this day EMS resides under the Department of Transportation. EMS systems are reimbursed for miles driven, not the assessment of the patient nor treatments given. ET3 finally allows EMS to collaborate with multiple arms of the healthcare system that bring patients to the right place the first time. 

The ET3 pilot officially began in 2020. While the COVID pandemic slowed the initiation of ET3 significantly, we are now seeing more and more EMS systems begin to pilot their ET3 system, including two within Missouri. With the data rolling in, two things have become increasingly apparent: 1) it is safe, and 2) it saves money for Medicare. While some patients who receive an initial telehealth consult in the home or transport to an alternative destination may eventually need to be seen in the Emergency Department, there has been no associated mortality or prolonged morbidity with these patients. While the pilot does not officially end until December 2025, there is already a push within CMS and from the national EMS community to make ET3 a permanent change to our EMS systems.

What does this mean for Emergency Medicine? It will divert some patients from the Emergency Department. However, this doesn’t mean that there isn’t a role for Emergency Medicine in the care of these patients. With many of our beds currently holding boarding patients for hours to days, we have become limited in the number of patients we can see due to lack of space. ET3 offers an opportunity to expand the number of patients we see by providing telehealth consults to patients with lower acuity complaints. Nationally, around 90% of ET3 calls end in a telehealth visit, highlighting how these patients are continuing to access care, just through alternative pathways. Emergency Medicine Physicians are a natural choice to provide telehealth discussions as they are excellent at triaging and directing care efficiently. Telehealth in the home also allows patients who would typically refuse transport (approximately 1/3 of all 911 calls) to still access care despite not going to the Emergency Department, potentially expanding opportunities patients have to contact physicians within the healthcare system. 

Telehealth consultant services that collaborate with EMS systems for ET3 services are making money. Currently, ET3 is only offered to patients on Medicare or who have insurance that is willing to compensate for alternative destination and telehealth services. There are a rising number of insurance companies and 3^rd party independent companies that are building telehealth consultant groups who directly collaborate with EMS. If an outside company provides telehealth services in your local area, it may divert insured patients away from your local hospitals and healthcare systems. If we are going to keep these patients within our local healthcare system, we need to start building our own telehealth consultant services and collaborating with our local EMS systems now. Reach out to your EMS partners today, and together we can deliver high quality healthcare for our patients.