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Quick Take: Cleveland Clinic reduces readmissions with telehealth

The Cleveland Clinic shares ET3 success with its Virtual Emergency Medicine Program


In the Cleveland Clinic’s ET3 Model, EMS received payment for alternative destination transportation or treatment on the scene. EMS providers had access via video to a board-certified emergency medicine physician who could assist with triage and treatment.

In a recent Becker’s Hospital Review webinar exploring the role of telehealth in EMS care, representatives from the Cleveland Clinic shared their recent success with ET3 and virtual care.

In “Telehealth in Transit: How Cleveland Clinic Achieves ED Avoidance & Reduced Readmissions through its ET3 Model and Other Virtual Care Programs,” Dr. Bryan Graham and Chris O’Rourke discussed how the Cleveland Clinic’s ET3 Model has affected emergency medical care, challenges they faced in implementing the program and expectations for the future.

About the speakers

  • B. Bryan Graham, DO, FACEP, is medical director, Virtual Emergency Medicine Program at the Cleveland Clinic
  • Chris O’Rourke, MHSA, is institute administrator, Emergency Services Institute at the Cleveland Clinic

In the Cleveland Clinic’s ET3 Model, EMS received payment for alternative destination transportation or treatment on the scene. EMS providers had access via video to a board-certified emergency medicine physician who could assist with triage and treatment.

Top quotes on the Cleveland Clinic’s use of telehealth

“This system empowers EMS to take patients to alternative destinations or provide treatment on scene with appropriate compensation.” — Chris O’Rourke

“We saw this as the next step in the EMS frontier, to extend more hospital resources into the community” — B. Bryan Graham

“We’ve been able to show that we’ve been able to treat these patients safely and effectively.” — Chris O’Rourke

Top takeaways on telehealth and ET3

Here are the top takeaways on how the Cleveland Clinic scaled and grew its Virtual ED Model to divert unnecessary emergency department admissions and reduce readmission, while providing emergency care in the field.

1. Virtual care is not just for low acuity patients

Even sick patients who would ultimately end up in the ED or hospitalized had some benefit from this program, especially in cases where there was a long transport time or where important field interventions made a difference in patient care. Having a video link to an emergency medicine physician gave EMS providers another resource to utilize and another set of eyes when it came to making critical decisions in the field.

2. Telehealth ultimately saves money

With this system in place, fewer patients were transported to the ED when they didn’t need to be. EMS were able to treat approximately 70% of patients on scene without transport. Additionally, the on-scene time itself was decreased, allowing EMS agencies to get back into service sooner. Patients were saved an expensive ED bill and still received the treatment they needed in a timely manner.

3. Good technology is key to success

A big part of this program included virtual visits with an emergency medicine physician. Patients would be evaluated in the field and then triaged to where they ultimately needed to be – whether it was the ED, primary care office, rehab center or if they could remain home after receiving treatment in the field. It was crucial to have a technology platform that worked consistently and was easy to use for all parties involved. Long wait times, bad connections or unfriendly user interface would create barriers to effective patient care.

4. Every EMS agency/health partner is different

Cleveland Clinic included 184 participants in 36 different states in both rural and urban areas in this program. Obviously, every EMS agency and local community was different, with varying amount of skill and available resources. When looking to implement an ET3 model in your community, it’s important to review local EMS protocols and recognize what resources you do and don’t have in your community.


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Looking to the future of telemedicine in EMS

Graham and O’Rourke made a couple points made about how the future may change their program, noting COVID allowed for the acceleration of virtual medicine and public health waivers allowed reimbursement for emergency medicine services in the field or virtual space. Although it’s likely that virtual medicine is going to become a bigger part of patient care in the future, reimbursement may change slightly once the waivers end.

Another point the speakers made is that the ET3 model will drastically change EMS reimbursement. If the trend continues and there is more utilization across the country, EMS will likely receive more reimbursement for the treatment they provide, rather than only receiving payment for patient transfer to the ED.

Learn more about ET3, telehealth and treat in place with these resources from EMS1:

Marianne Meyers, BS, is a third-year medical student at the University of Washington School of Medicine interested in pursuing emergency medicine. Previously, she was a member of the Santa Clara University collegiate EMS squad where she received her B.S. in Public Health Science. Additionally, she has worked with the King County Public Health Department in Seattle, Washington studying EMT naloxone administration.