Innovation Spotlight: ET3: Emergency Triage, Treat & Transport
American Medical Response (AMR), a GMR solution, is pioneering the Emergency Triage, Treat and Transport (ET3) program across the U.S., with many of the innovative programs already in operation and plans to implement the groundbreaking medical emergency protocol in several more U.S states by year’s end. AMR was selected in more communities and more states than any other medical transport provider.
Developed by the Center for Medicare and Medicaid Innovation (CMMI), ET3 is a five-year program aimed at reducing overcrowding in hospital emergency departments, driving down Medicare and Medicaid costs, and increasing healthcare options for Medicare Fee for Service (FFS) beneficiaries.
Patients are assessed by AMR teams on site, using protocols developed by GMR Chief Medical Officer, Dr. Ed Racht. Those patients can be treated on site by paramedics or EMTs, examined by a physician via telehealth, and then transported, if necessary, to a care facility appropriate to their medical needs. Importantly, this will not always be a hospital emergency department, which is the only option currently outside of ET3.
ET3 Brings the Doctor to the Patient or Patient to the Doctor
For low-acuity complaints, where the decision is either on-site, telehealth treatment or transport to an alternative destination, our protocols allow our specially trained EMTs and paramedics to conduct triage while the patient’s Medicare Family FFS benefits are confirmed.
If on-site telehealth consultation is sufficient for the needs of the patient, AMR partner Envision Physician Services delivers treatment in place. The Envision Telemedicine model allows AMR to leverage the highly regarded healthcare company’s value-based services. AMR and Envision use the cutting-edge technology platform, eVisit, to enable seamless remote care, connecting patient with doctor in real time to make important care decisions.
When a patient’s condition requires transport, but to an alternative destination (AD) rather than an emergency room, AMR has partnered with local healthcare facilities to provide a continuum of high-quality care to meet the specific needs of the patient. Local support from urgent care and behavioral health partners as ADs is a fundamental element to the success of ET3. These alternate transport locations cut down on emergency department (ED) overcrowding and generally cost less than an ED.
For the ADs, there are benefits as well. AMR crews pre-check Medicare patients, so the receiving location knows that they are covered by insurance and are suffering from an injury or illness that the AD is able to treat effectively.
Real-World Impact of ET3
“The implementation of ET3 into the Boulder, Colorado, operation has allowed our crews to better serve our community by helping to reduce unnecessary transports to our local emergency department that is still working through the increased volume associated with the pandemic,” says Brittany Buss, paramedic captain. “The ability to transport to a destination other than an emergency department has allowed our mental health patients to get to a location that is better able to provide them the resources they need. Overall, we have heard positive feedback from the patients that have qualified for this program, and we are excited to see it continue to grow.”
One patient from DeKalb County, Georgia agrees with Buss’ assessment, saying the program provided an alternate intervention that avoided potential contact with COVID-19. “We connected through our county 911 service, and we were very pleased with the experience. The doctor was wonderful, kind, and gave us good advice. The hospitals are full of Covid patients, and we didn't want to go there. We would have had to wait hours and didn’t want to be exposed to Covid. Thanks for providing this option.”
EMS crews are also reacting well to the program with some saying it’s improved employee attitudes among emergency responders and is creating a greater sense of teamwork with members of leadership.
“There is no doubt that being involved in the ET3 Pilot has brought energy to our crews. Having a new role in the healthcare system—one where they can not only be an advocate for the patient but also the EMS System, the greater healthcare system, and the community at large—has given many a new perspective on their careers and seemingly improved their job satisfaction,” says Dr. Todd Heffern, EMS Medical Doctor, Knoxville, Tennessee. “Being a part of the ET3 program has taken a lot of time and energy, but it has stimulated our leadership to work together to improve communication, training, and quality assessment practices—things that will all improve our normal operations and clinical care.”
The Program’s Future
ET3 has been hailed as a model that not only reduces unnecessary or avoidable emergency department visits, but also one that lowers the overall healthcare spend of the patient. AMR, the largest participant in the ET3 program, is looking to implement the model in 14 states before the end of 2021 — when all participating markets must be live as part of the five-year pilot program. The company now has 62 participants out of 184 total, approximately 34 percent. Today, 20 markets are scheduled for implementation with the remaining looking to secure local alternative destination partners to bring this program to their community.
Additional payor support is imperative to grow this program locally. Currently, Medicaid agencies in three states are planning to offer this program to their beneficiaries, and AMR is working with other states to increase support in the near future. And while the cost-saving benefits of ET3 would only apply to Medicare/Medicaid/ Private Pay patients at this time, AMR is hoping to show the efficacy and advantages of such programs to other payors as well.
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