Health Policy News often features Medicaid-related policy topics; this month, we are featuring the first in a series of pieces that touch on Medicare policy—specifically, Emergency Medical Services (EMS). PCG is fortunate to have retired Las Vegas Deputy Fire Chief Ken Riddle leading our work in this area.
We spent time with Ret. Deputy Chief Riddle discussing his current work for PCG, as well as how recent policy changes present EMS providers—from large-scale, city-based operations to tiny, rural providers—an opportunity to revisit the efficiency and cost-effectiveness of current service delivery models.
With Chief Riddle’s guidance, PCG is partnering with all types of agencies and organizations to focus on the cost of providing emergency services and evaluating the effectiveness and efficiency of fire or EMS operations.
The recent policy changes that PCG/Ret. Deputy Chief Riddle are helping entities implement include:
Medicare Ground Ambulance Data Collection System
As part of the Bipartisan Budget Act of 2018, the Centers for Medicare and Medicaid Services (CMS) requires that all providers of ground ambulance services collect and report expenditures, revenues, utilization, and other departmental statistics. This data will be used to assess current payment rates and inform future reimbursement rates.
In November 2019, CMS selected 2,600 ambulance providers to complete the Medicare Cost Survey, noting that failure to sufficiently submit the required information will result in a 10 percent reduction to payments under the Ambulance Fee Schedule (AFS) for one year.” CMS outlines that precise and complete cost data collection is critical to establish adequate future rates. The program kicked off on January 1, 2020 and will continue through 2024.
CMS released an FAQ in December 2019 to assist ground ambulance providers in submitting the required data, as well as outline how this data will be used to report to Congress on the adequacy of Medicare rates for ambulance providers.
For states and provider organizations with additional questions, PCG has prepared a fact sheet that details the services we offer in this area. To view it, click the thumbnail image on the left.
Emergency Triage, Treatment and Transport (ET3)
Emergency Triage, Treat, and Transport, or ET3, is a new initiative led by the CMS Innovation Center (CMMI) intended to honor the breadth of services provided by ground EMS providers. By introducing new alternative care and Medicare payment options to participating EMS providers, ET3 is designed to appropriately address the healthcare needs of Medicare Fee-for-Service (FFS) beneficiaries. CMMI released insights and an FAQ for those interested in participating in the program in early 2019, and the demonstration is scheduled to kick off this spring.
By participating in ET3, EMS providers and 911 dispatch authorities can reduce unnecessary emergency room usage, reduce healthcare costs, and improve quality of care. This voluntary, five-year program will allow EMS providers and CMS to test the viability and results of this value-based payment arrangement.
Additional benefits of this program include:
- Potential financial awards to develop or expand 911 emergency call center(s) for government entities
- Reimbursement for Treat No Transport (TNT) patients.
- Integration of onsite and telehealth treatment by credentialed medical providers
PCG has prepared a fact sheet on this topic that outlines even more benefits of participating in ET3—as well as ways PCG may be able to assist organizations that are slated to start their participation in the five-year demonstration. Click the thumbnail image on the right to read it.
Ret. Deputy Chief Riddle is hosting a series of webinars next month specifically for members of the International Association of Fire Chiefs (IAFC) focused on the Medicare ground ambulance data collection program. HPN will be adapting this webinar series into a single informative webinar that we will open up to our readers, so stay tuned for an opportunity to connect on this topic soon!