CMS felt it couldn’t determine the impact of the model because there weren’t enough participants. That’s disappointing for MIH providers. However, CMS did state that lessons learned during the course of the model could be useful in the future. So, there’s hope of developing another payment strategy.
The design of the current model contributed to its limitations. CMS only accepted one round of applicants and limited those applicants to urban area providers. They hinted at a second round open to rural providers, but this never materialized.
Timing was also against ET3. The implementation began at the start of the COVID-19 public health emergency. Relief efforts implemented during this time opened up ET3-like payments to every ambulance service. Providers were able to bill for certain in-place treatments or for transportation to locations other than a hospital within local and state guidelines without participating in ET3.
Future Opportunities
Payers other than Medicare have implemented similar programs that we can study to understand the effects on cost and outcomes. Healthcare challenges seen across the country, including hospital overcrowding, extended off-load times, hospital closures, and staffing shortages, have led local officials to reconsider taking every patient to a hospital.
EMS agencies and state regulators must make policy changes to allow for alternative patient care options. Healthcare organizations across the country are adopting more patient-centered care delivery models designed to keep patients out of the hospital. State regulations need to keep up with these shifts by expanding how EMTs, paramedics, and MIH teams can operate.
Payers appear to be on board with these shifts. Many state Medicaid programs, commercial insurance plans and even Medicare HMOs are paying for in-home treatment or transport to locations other than hospitals. For example, Maryland and Indiana have established programs to help fund treatment in place after 911 response, MIH-focused models, and unreimbursed EMS care.
Many states are following suit and more agencies, members, and partners of NAMIHP have successfully navigated contracts for MIH and Community Paramedicine revenue. These are often tied to patient outcome and cost goals, from preventing unnecessary 911 calls and hospitalizations to better disease management and resource allocation.
Over time, these innovative healthcare delivery models will develop enough data to more fully analyze the impact on patient outcomes and costs, giving payers across every state a clearer picture of the impact of these programs.
Pioneers in this industry have already demonstrated cost savings and improved patient outcomes. If those outcomes continue to be realized, Medicare and other payers will likely back these programs without the need for a second pilot payment model to confirm billing viability.
Data collection by teams continues to be an essential goal to support efforts for fair compensation. Despite the setbacks experienced with the ET3 model, MIH is growing to meet the needs of patients and the healthcare industry. Payers are still motivated to improve patient care.
ET3 and these other payment models taught us lessons, leaving the door open for payment models that support mobile integrated health teams.