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5 things to know about the ET3 reimbursement model

Find out the specifics of the Emergency Treat, Triage and Transport payment model, and how will it affect your EMS agency

By Rachel Engel

In a joint announcement, the Centers for Medicare and Medicaid Services (CMS) and the U.S. Department of Health and Human Services (HHS) announced the Emergency Treat, Triage and Transport (ET3) payment model which will make Medicare reimbursement available for certain non-transport ambulance services and ambulance transports to alternate destinations.

What is ET3, and how will it change the day-to-day operations of your EMS agency? Find out the five most important things to know about the ET3 reimbursement model and how it could be a watershed moment for the industry.

1. ET3 encourages the use of community paramedicine programs

The Emergency Treat, Triage and Transport pay model is designed to decrease the burden on emergency departments and connect the patient with the best place for care, which many not necessarily be the hospital.

Agencies that apply to operate under the ET3 model will be authorized to transport patients to other destinations, including doctors’ offices, as well as encourage the use of community paramedicine programs, when applicable, that can assist patients without the need for more complex care.

2. The ET3 model provides Medicare transportation and Medicare reimbursement

What makes the ET3 model so worthwhile for EMS agencies is the authorization of Medicare transportation and Medicare reimbursement. Currently, agencies only receive payment from Medicare if they transport patients to hospitals, critical access hospitals, skilled nursing facilities and dialysis centers, regardless of whether the patient’s needs could be met at a lower-acuity facility.

When using the ET3 pay model, however, agencies are eligible to be paid for Medicare transportation and receive Medicare reimbursement, based on their determination upon patient triage at the scene. The ET3 model could also save patients out-of-pocket costs when utilizing community paramedicine programs and by avoiding costly emergency department visits.

3. The ET3 model was designed to improve quality, lower costs, and demand higher efficiency

The new model aims to promote a patient-centered system that provides the correct level of care at the most adequate facility for emergency.

This means that agencies can utilize doctors’ offices, urgent care facilities and other community paramedicine or mobile integrated healthcare options to meet the needs of patients. By providing a level of care that matches the health need, EMS providers will improve the quality of life and circumstances of the patient in the moment, as well as save the beneficiary money by potentially avoiding an unnecessary emergency department trip and allow EMS providers to quickly and efficiently move on to more emergent cases.

4. ET3 provides an emphasis on triage

As part of the new reimbursement plan, 911 call centers that are operating under the ET3 system will screen callers to find those that are eligible to speak with medical triage services prior to an ambulance being dispatched.

This screening allows for community paramedicine, or other de-escalated methods of care, to be used when responding to calls, as well as to ascertain information that could direct the ambulance to a lower level of care, such as an urgent care facility. Under the ET3 system, Medicare reimbursement will be provided for these calls, as well.

5. The ET3 model puts patient care first

By better understanding the needs of the patient through triage screening at the 911 operator level, EMS agencies are positioned to provide more in-depth, thoughtful and deliberate care to patients, while also being compensated.

“Imagine a future where EMS is incentivized to:

  • Transport a chronic inebriate to a sobering center.
  • Stay on scene with a fall patient to review medications and identify trip hazards.
  • Drop off a patient with a respiratory infection at an urgent care center.
  • Educate an asthma patient about triggers and how to prevent an attack.”

The voluntary five-year performance program will begin in January 2020, and more information will be released over the next few months.

Rachel Engel is an award-winning journalist and the senior editor of and In addition to her regular editing duties, Engel seeks to tell the heroic, human stories of first responders and the importance of their work. She earned her bachelor’s degree in communications from Cameron University in Lawton, Oklahoma, and began her career as a freelance writer, focusing on government and military issues. Engel joined Lexipol in 2015 and has since reported on issues related to public safety. Engel lives in Wichita, Kansas. She can be reached via email.