Bringing It Home: The Shift in Where Health Care Is Delivered

Evidence suggests that shifting to value-based reimbursement—such as rewarding paramedics for transporting patients to primary care instead of the ED—could lead to a potential savings of $560 million per year. In addition, emergency medical services (EMS) pilot programs are building the case for integrated teams and telehealth-enabled services. In one study of 5570 patients in Houston, researchers used telehealth services, social services, and alternative transportation to navigate patients away from the ED and toward primary care settings whenever possible. As a result, ambulance transports to the ED decreased by 56%, and EMS productivity (defined as “back in service”—the time from dispatch of the EMS team to being available to be dispatched again) was improved by 44 minutes. Such outcomes are prompting the Centers for Medicare & Medicaid Services (CMS) to incentivize treating patients in the least expensive setting. This summer, CMS is launching a request for applications for the Emergency Triage, Treat and Transport (ET3) initiative, a 5-year project slated to begin in January 2020. Under this payment model, ambulance care teams will have flexibility in providing care to Medicare beneficiaries, including the ability to (1) evaluate and transport a patient directly to primary care or urgent care or to (2) evaluate and treat the patient on the scene with the support of a qualified health care professional, in person or through telehealth.