Quantifying Regional Differences in Ambulance-Sourced Avoidable ED Rates

Assessing Key Markets for the ET3 Model

 

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Overview

In an effort to increase the quality of care for patients and reduce avoidable transports to the ED, the Center for Medicare and Medicaid Innovation (CMMI) developed an innovative payment model called Emergency Triage, Treat, and Transport, or ET3 for short. This model really looks to redefine emergency ground ambulance services, who until this model would only be paid by Medicare when transporting patients to approved facilities including hospitals (EDs), even if this was not the most appropriate care setting for the patient’s need. 

Dashboard

This dashboard offers insights on county-level ambulance-sourced ED claims using 2019 Medicare Fee-for-Service data. To use this dashboard, use the state and county filter to select the geographic areas you are interested in learning about. 

Learn more about the ambulance-sourced avoidable ED visits, and the ET3 model on the blog!

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Frequently Asked Questions

What is the ET3 model? 

    This model will pay ambulance providers not just for transport to the ED, but also transports to alternative locations like a doctor’s office or an urgent care facility. While not required, providers also have the ability to treat patients in place through onsite or telehealth services.

    The participants of the ET3 program will be Medicare-enrolled ambulance providers and hospital-owned ambulance providers. In addition, local governments will play a role as 911 dispatch plays an important role in the model intervention.

    To be able to estimate the ED episodes that may have been avoided through an ET3-like program, we applied the NYU Billings Avoidable ED logic.
    This avoidable ED logic, which we have coded and integrated throughout our products, uses the diagnosis codes on the claim to determine the likelihood the case falls into different avoidable classifications, based on a thorough review of 6,000 ED claims by a panel of experts.
    Out of the avoidable classifications listed in the methodology, we combined the (1) Non-Emergent and (2) Emergent/Primary Care Treatable categories into those ED visits that would potentially be applicable to an ET3-like program, where these patients would receive care in place or in an alternative location such as a doctor’s office.
    The Emergent – ED Care Needed – Preventable/Avoidable bucket, although often considered an avoidable classification, was not used in this analysis, as these episodes would still require transport to the ED.

    With CareJourney and our access to 100% Medicare fee-for-service data and commercial data, we have the ability to take this context and drive actionable next steps. Working with CareJourney, members can:
    1. Leverage the Provider Performance Index to see how their PCPs perform relative to their peers in high avoidable ED counties
    2. Identify providers with the highest number of attributed patients with avoidable ED visits to determine the most impactful interventions to lower avoidable ED utilization and costsIdentify the top ambulance providers in a given region
    3. Identify “key players” in an ET3-like program
    4. Generate a list of patients with high avoidable ED utilization and their PCPs, to help establish proper care coordination and action plans to help reduce future avoidable ED episodes

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Mallory Cary, ACO Operations Director
Prominence Health Plan, a subsidiary of Universal Health Services (UHS)

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