Emergency Triage, Treat & Transport (ET3)

Alternatives to the Emergency Department Offered to 911 Callers with “Traditional” Medicare

As a result of a new Medicare program, some District residents are now eligible to be treated in their home or transported to an alternative healthcare destination

Mrs. Olson’s (fictitious patient name) blood pressure is higher than usual.  She has a history of high blood pressure, but other than that she isn’t experiencing any other symptoms.  Reluctantly, she calls 911 – not relishing a trip to the Emergency Department, where she may have to wait a long time to receive treatment.

Mr. Lyons (fictitious patient name) activates his medical alert button when he starts to have a seizure.  The seizure is like many he’s had before, and the EMS crew confirms his vital signs are normal.

In the past, both patients would be transported to the Emergency Department.  But under a new Medicare program offered exclusively to Medicare Fee-for-Service (FFS), or “Traditional” Medicare beneficiaries, Mrs. Olson and Mr. Lyons can choose to remain at home and be treated by a doctor or nurse practitioner who conducts a virtual visit on the telephone facilitated by the District’s Critical Care Paramedics.  

Under another scenario, a 911 caller has had a minor fall and sprains an ankle.  Instead of transporting the patient to the Emergency Department, EMS crews offer to take her to an urgent care, where the medical care offered is appropriate to her condition but less costly and time-consuming.

The goal of the five-year program, called ET3 – Emergency Triage, Treat, and Transport – is to provide Medicare FFS beneficiaries with the most appropriate emergency service at the right time and place.  The ET3 model aims to lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports.  In the Spring of 2020, MFPD became one of 206 applicants from 36 states and the District of Columbia who were approved by the Center for Medicare and Medicaid Services (CMS) to participate in ET3.  

ET3 has been a success.  MFPD is one of the top 5 performing agencies judged by number of interventions.  There have been no negative outcomes, and patient feedback has been positive, focusing on the benefits of not spending hours in a hospital Emergency Department.  Total Access Urgent Care is our alternative destination partner and Mercy Virtual is our telehealth partner.  Agreements with other practitioners in specialty areas, including behavioral health, are anticipated.  

ET3 has provided MFPD personnel with valuable data and experience.  While only available to Medicare FFS patients now, the hope is that the program’s success will lead other insurers to embrace the model.  “In the long run,” said Dr. Melissa Kroll, MFPD’s Assistant Medical Director, “when our patients call 911, we would like to offer multiple services, ranging from critical care management of the severely ill to providing treatment for chronic conditions within the home.”