ET3 and Telemedicine: What You Need to Know

November 3, 2022

Over the past few years, a select group of EMS agencies around the nation have been piloting a program created by the Center for Medicaid Services called Emergency Triage, Treat, and Transport of ET3, a new model of care that purports to provide better services to patients while reducing the burdens and costs to EMS systems. One of the program’s components is the ability of EMS agencies to use telemedicine in the field. Read on to see how telemedicine and ET3 come together to give EMS agencies a new response toolbox. 

What is ET3? 

Today’s payment model for EMS services is primarily predicated on EMS crews transporting patients to specific facility types, such as hospitals which can create a skewed incentive model focusing on transport over the appropriate level of care needed for a particular patient. In 2019, the Center for Medicaid Services announced a new program called ET3, or Emergency Triage, Treat, and Transport. According to CMS, the program is a “voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare Fee-for-Service (FFS) beneficiaries following a 9-1-1 call”. ET3 looks to create a model that provides more patient-centered care, reduces inappropriate utilization of EMS, and creates a more robust EMS network.

EMS agencies participating in the ET3 program can receive payment from Medicare for transporting patients to alternative destination partners such as an urgent care clinic, ACO, or primary care doctor’s clinic or for using treatment-in-place services such as telehealth or through community paramedicine response. 

Treatment in Place and Telemedicine

Participating agencies can take advantage of treatment-in-place programs by treating patients in person or using a telehealth program. For example, if a patient needs a changed bandage dressing and calls 9-1-1, a paramedic can now choose to clean the wound and update the bandage dressing rather than transporting the patient to the hospital to receive care. EMS agencies can also use what CMS calls a qualified health care practitioner or QHCP to deliver care, such as a mental health counselor or telemedicine services.

Partnering with Telemedicine Providers

EMS agencies looking to take advantage of telemedicine in the ET3 program need to partner with Medicare-enrolled telemedicine providers. In addition, these telehealth providers need to use HIPAA-compliant software that allows for real-time two-way audio and video communication between the patient, physicians, or other qualified healthcare practitioners. 

Benefits of Telemedicine in ET3

Care Accessibility Expansion

Telemedicine unlocks previously closed healthcare access for those traditionally unable to receive telehealth, such as the elderly who may lack access to the technology needed to use telehealth software or those who live in rural areas. Instead of driving long distances to see physicians or receive a consultation from a mental health professional, patients can immediately make a connection and access care. 

Holistic Patient Services 

Since the new model incentivizes treating patients where they are instead of transporting them; patients can now receive care at the right time and place and take advantage of different healthcare modalities, including mental health, social services, nutrition planning, and more. By providing patients with increased healthcare options, patients can see improved outcomes and potentially reduce the number of calls to 9-1-1. 

Crew Burnout Reduction & System Prioritization 

More than 50% of EMS crews report symptoms and signs of burnout. Two critical factors in burnout are heavy workloads and perceived misuse of EMS services. Telehealth can help reduce burnout by offering an alternative care option and giving those lower acuity patients a resource to contact rather than EMS. Dispatchers can also use telemedicine to prioritize high-acuity calls allowing crews to focus on the cases with the most substantial need creating a better, more streamlined prioritization system for EMS. 

Lower-Risk Investment

One of the challenges many EMS agencies have historically faced when wanting to implement new telehealth programs is that they lack the funding to provide them to their communities. The reimbursement model created by CMS allows EMS agencies to deliver telehealth services with less financial risk to their agency. In addition, once used for Medicare patients, EMS agencies can more readily highlight the benefits of the services to their community and seek to partner with payers to expand coverage. 

Although the ET3 program is only a five-year effort, there have already been multiple expansions and funding opportunities, and many EMS agencies are reporting the benefits of the new model. Hopefully, the ET3 model will become the “new normal,” unlocking advantages for patients and EMS crews.