Emergency Triage, Treat, and Transport (ET3) Model

The Centers for Medicare & Medicaid Services released a detailed fact sheet detailing the Emergency Triage, Treat, and Transport (ET3) model. It provides significant details on the scope of the project and key benchmarks – Michael Shabkie 

Emergency Triage, Treat, and Transport (ET3) Model
The Center for Medicare and Medicaid Innovation’s (Innovation Center) Emergency Triage, Treat, and Transport (ET3) Model is a voluntary, five-year payment model that will provide greater flexibility to ambulance care teams to address emergency health care needs of Medicare beneficiaries following a 911 call. Under the ET3 model, the Centers for Medicare & Medicaid Services (CMS) will pay participating ambulance suppliers and providers to:

  1. Transport an individual to a hospital emergency department (ED) or other destination covered under the regulations
  2. Transport to an alternative destination (such as a primary care doctor’s office or an urgent care clinic),
  3. Provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth.

The model will allow beneficiaries to access the most appropriate emergency services at the right time and place. The model will also encourage local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches to promote successful model implementation by establishing a medical triage line for low-acuity 911 calls. As a result, the ET3 model aims to improve quality and lower costs by reducing avoidable transports to the ED and unnecessary hospitalizations following those transports.

Why develop a model for emergency medical services (EMS) innovation?
Currently, Medicare regulations only allow payment for emergency ground ambulance services when individuals are transported to hospitals, critical access hospitals, skilled nursing facilities, and dialysis centers. Most beneficiaries who call 911 with a medical emergency are therefore transported to one of these facilities, and most often to a hospital ED, even when a lower-acuity destination may more appropriately meet an individual’s needs.

An earlier White Paper by the U.S. Departments of Health and Human Services and Transportation found that Medicare could save $560 million per year by transporting individuals to doctors’ offices rather than a hospital ED; taking into account avoided inpatient hospitalizations and opportunities for treating in place may garner further savings and quality of care improvements. Thus, there is great opportunity for improvement in care quality and reduction in costs to the Medicare program through innovation in emergency medical services (EMS).

In addition, a range of EMS innovations across the care continuum has been instituted throughout the country. The ET3 Model builds upon design components and lessons learned from such innovations as well as several EMS-related Innovation Center Health Care Innovation Award (HCIA) recipients.

How does the ET3 model transform the ambulance system?
With the support of local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches, ambulance suppliers and providers will triage people seeking emergency care based on their presenting needs. The model aims to ensure Medicare Fee-For-Service beneficiaries receive the most appropriate care, at the right time, and in the right place. As depicted in the figure below, the model may help make EMS systems more efficient and will provide beneficiaries broader access to the care they need. Beneficiaries who receive treatment from alternative destinations may also save on out-of-pocket costs. An individual can always choose to be brought to an ED if he/she prefers.

This flow chart outlines how emergency health care needs of Medicare beneficiaries would be addressed following a 911 call, and the new services under the ET3 model.  At the top of the chart is “911 call received.” After the 911 call is received an ambulance service is initiated OR a health care professional discusses health concern(s) with the individual via a medical triage line. The medical triage line that connects an individual with a health care professional is a new service under the ET3 model.  If an ambulance is initiated, one of two things could happen. One, the ambulance could transport the individual to receive additional care, either to another care facility like urgent care, or to a covered destination like the emergency department. OR two, the ambulance arrives, but does not transport the individual. In this second scenario, as part of the ambulance care team, a qualified health care practitioner (either on site or through audio or video conferencing) provides treatment in place. The ambulance transporting the individual to another care facility like urgent care is a new service under the ET3 model as is treatment in place either on site or through audio or video conferencing via a qualified health care practitioner.

What are the model’s goals?
The ET3 model aims to reduce expenditures and preserve or enhance quality of care by:

• Providing person-centered care, such that beneficiaries receive the appropriate level of care delivered safely at the right time and place while having greater control of their healthcare through the availability of more options
• Encouraging appropriate utilization of services to meet health care needs effectively.
• Increasing efficiency in the EMS system to more readily respond to and focus on high-acuity cases, such as heart attacks and strokes.

How will the model achieve these goals?
The ET3 Model aims to achieve these goals through three core features:

1. Quality-adjusted payments for EMS innovations. Provide new payment options for transport and treatment in place following a 911 call Tie payment to performance milestones to hold participants accountable for quality

2. Support for aligned regional markets. Make cooperative agreements available to local governments, its designees, or other entities that operate or have authority over one or more 911 dispatches acting on their behalf in regions where selected model participants operate Focus funding on the establishment of medical triage lines to ensure appropriate use of EMS resources and advance multi-payer adoption to support overall success and sustainability.

3. Enhanced monitoring and enforcement. Build accountability through the monitoring of specific quality metrics and adverse events Include robust enforcement to ensure patient safety and program integrity

Who can participate in the model?
The key participants in the ET3 Model will be Medicare-enrolled ambulance service suppliers and hospital-owned ambulance providers. In addition, to advance regional alignment, local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic areas where ambulance suppliers and providers have been selected to participate in the model will have an opportunity to apply for cooperative agreement funding.
Together, ambulance suppliers and providers will focus on direct services, while local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches will create a supportive structure to ensure successful and sustainable delivery of those services.

Ambulance Suppliers and Providers will support EMS innovation by transporting Medicare beneficiaries to currently covered destinations (e.g., ED ) or alternative destinations, and by providing treatment in place with a qualified health care practitioner (on site or via telehealth). Local Governments, its designees, or other entities that operate or have authority over one or more 911 dispatcheswill promote successful model implementation by establishing a medical triage line for low-acuity calls received via their 911 dispatch system.

Who is eligible for the model interventions?
Any individual who calls 911 and is connected to a dispatch system that has incorporated a medical triage line under the model would be screened for eligibility for medical triage services prior to ambulance initiation. Upon arriving on scene, participating ambulance suppliers and providers may triage Medicare FFS beneficiaries to one of the model’s interventions upon ambulance dispatch following a 911 call. As part of a multi-payer alignment strategy, the Innovation Center will encourage ET3 Model participants to partner with additional payers, including state Medicaid agencies, to provide similar interventions to all people in their geographic areas.

How may Medicare beneficiaries and their families benefit from the ET3 model?
Participating ambulance suppliers and providers will have greater flexibility regarding where and how a beneficiary receives care following an emergency. By paying for ambulance transport to new destinations or treatment in place for beneficiaries with lower-acuity needs, beneficiaries will gain new ways of accessing care settings during an emergency. As a result, the model may allow beneficiaries to avoid hours spent in the ED as well as reduce exposure to hospital-acquired conditions.

How will funding be awarded?
The Innovation Center anticipates releasing a Request for Applications (RFA) in Summer 2019 to solicit Medicare-enrolled ambulance suppliers and providers. Once participants have been selected and announced, the Innovation Center anticipates issuing a Notice of Funding Opportunity (NOFO) in Fall 2019 for up to 40 of two-year cooperative agreements, available to local governments, their designees, or other entities that operate or have authority over one or more 911 dispatches in geographic locations where ambulance suppliers and providers have been selected to participate.
The Innovation Center anticipates utilizing a phased approach with up to three rounds of RFAs, up to two releases of NOFOs, and staggered performance start dates. The staged approach across multiple application rounds is designed to advance key design elements of the ET3 Model and optimize overall impact, including regional uptake of its innovations and multi-payer alignment.

What is the model timeline?
The ET3 Model will have a five-year performance period. The anticipated start date is January 2020. The performance period for all participants, regardless of start date, will end at the same time; thus, only applicants selected through the first RFA will participate for the full five years.

Resources and Support
For more information on the ET3 Model, please visit: https://innovation.cms.gov/initiatives/et3/. If stakeholders have questions on the ET3 Model, they can send an email to ET3Model@cms.hhs.gov.

The Non Emergency Medical Transportation Accreditation Commission (NEMTAC) Proudly Launches New Website

We are pleased to announce the launch of our brand-new website and we’re excited to introduce you to our new look.

SCOTTSDALE, Ariz. – July 23, 2018 – PRLog — After months of hard work, we are delighted to officially announce the launch of our newly redesigned website at www.nemtac.org. We hope you find the new website fresh and modern; we worked hard to make sure it contains valuable information related to the non-emergency medical transportation (NEMT) industry.

Our goal with this new website is to provide our visitors an easier way to learn about NEMTAC and our important mission within the NEMT industry. We have designed it with you in mind, streamlining menus, simplifying navigation, building a responsive layout for all platforms and providing more resources and information on our accreditation and educational services.

We will continue to expand our resources to deliver the most updated and relevant information for the NEMT industry. Additionally, we will be constantly updating our content with helpful information, articles, blogs, educational content, NEMTAC announcements and accreditation success stories.

We encourage everyone to visit and explore the site. If you have any questions or feedback you would like to share with our team, please do so by filling out the form on our Contact us page. We look forward to staying connected.

About NEMTAC – The Non Emergency Medical Transportation Accreditation Commission (NEMTAC) was established as a nonprofit organization to enhance and promote the quality of care in America’s medical transportation system. NEMTAC standards represent industry best practices designed to ensure consistently high-quality customer care, safe vehicle operations and ethical business practices. In addition to accreditation, NEMTAC provides advanced education and training certificate programs to individuals seeking a career in the medical transportation industry.  For more information visit www.nemtac.org.

About the Non-Emergency Medical Transportation (NEMT) Industry – The NEMT industry provides a critical non-ambulance transportation link between patients and their medical care needs, including appointments with physicians and other services, such as dialysis, diagnostic tests or wound care. 17,000+ companies in the NEMT industry provide millions of transports annually for patients, typically for pre-scheduled services.  However, its estimated that missed care appointments due to a lack of transportation cost the U.S. healthcare system billions of dollars per year. The medical transportation industry is rapidly expanding to meet this need.

Contact
Michael Shabkie
***@nemtac.org

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https://www.prlog.org/12720208/1NOn Emergency Medical Transportation Accreditation Commission-01

Non Emergency Medical Transportation Accreditation Commission (NEMTAC) Gains Coveted Designation by the American National Standards Institute (ANSI)

SCOTTSDALE, Ariz. – July 16th, 2018 – The Non Emergency Medical Transportation Accreditation Commission (NEMTAC) today announced that it has been approved by the Executive Standards Council (ExSC) of the American National Standards Institute (ANSI) as an Accredited Standard Developer (ASD).

Founded in 1918, ANSI is a private, non-profit organization that coordinates, facilitates, and promotes the development of voluntary consensus standards that are relied upon by industry, government agencies, and consumers across the United States and around the world. ANSI accredited organizations – and the experts that populate them – work cooperatively to enhance service delivery and improve the competitiveness of businesses operating in the global marketplace.

“With active participation from subject-matter-experts on a variety of topics related to non-emergency medical transportation (NEMT), NEMTAC is developing a rigorous standards development process for the NEMT industry that includes review and approval by various Advisory Boards and our Board of Directors,” said Steve Lewis, NEMTAC Board President.

Approval to become a standards developer was granted based upon standards development procedures that meet or exceed ANSI’s due process requirements and that NEMTAC will ensure adequate resources are dedicated to NEMT standards development.

“NEMTAC is proud to join the ranks of ANSI Standards Developers,” said Melissa Jankowski, NEMTAC Executive Director, “With ANSI approval, the public can depend on NEMTAC Standards as a peer driven, independent, and effective means of identifying the NEMT industry’s best practices for quality, safety and ethical business practices.”

About NEMTAC – The Non Emergency Medical Transportation Accreditation Commission (NEMTAC) was established as a nonprofit organization to enhance and promote the quality of care in America’s medical transportation system. NEMTAC standards represent industry best practices designed to ensure consistently high-quality customer care, safe vehicle operations and ethical business practices. In addition to accreditation, NEMTAC provides advanced education and training certificate programs to individuals seeking a career in the medical transportation industry.  For more information visit www.nemtac.org.

About the Non-Emergency Medical Transportation (NEMT) Industry – The NEMT industry provides a critical non-ambulance transportation link between patients and their medical care needs, including appointments with physicians and other services, such as dialysis, diagnostic tests or wound care. 17,000+ companies in the NEMT industry provide millions of transports annually for patients, typically for pre-scheduled services.  However, its estimated that missed care appointments due to a lack of transportation cost the U.S. healthcare system billions of dollars per year. The medical transportation industry is rapidly expanding to meet this need.

Non Emergency Medical Transportation Accreditation Commission Announces Founding Board of Directors

SCOTTSDALE, Ariz. – June 27, 2018 – PRLog — The Non Emergency Medical Transportation Accreditation Commission (NEMTAC) is pleased to announce the selection of their Founding Board of Directors. NEMTAC is a new non-profit healthcare organization dedicated to championing standards and best practices for providers, buyers, regulators and those who are served by non-emergency medical transportation.

With stable medical conditions and often pre-scheduled appointments, non-emergency medical transportation (NEMT) customers rely on this vital service provided by over 17,000 companies nationwide. This rapidly growing  industry provides millions of transports annually connecting patients with their care.

The new board members come from diverse backgrounds and include current and former executives from the non-emergency medical transportation (NEMT) industry, healthcare, large non-profits and the ambulance industry. “We have a very strong leadership foundation in place and we couldn’t be more pleased with these appointments. Each of these individuals’ deep professional backgrounds and passionate commitment to the non-emergency medical transportation industry will bring insightful perspectives to our Board,” said Michael Shabkie, NEMTAC Founder.

The Board of Directors, comprised of a multidisciplinary team with vast experience in business, healthcare, technology and all levels of medical transportation, includes:

·       Steve Lewis, NEMTAC Board President

·       Robert Brown, NEMTAC Board Vice President

·       Peter Hicks, NEMTAC Board Secretary

·       Michael Shabkie, Board Treasurer

·       Stan Sipes, NEMTAC Board Member

·       Chris Kelly, NEMTAC Board Member

·       David Marhoffer, NEMTAC Board Member

In announcing the first NEMTAC Board Members, Melissa Jankowski, Executive Director said, “It’s important to be surrounded by the right people and we’ve assembled a very experienced and talented group that will help drive the vision of NEMTAC and assist us in forming a path of success.” Ms. Jankowski further stated, “Over the coming months, the board will continue to search for additional world-class directors and a wide range of stakeholders to serve on committees and task forces who will develop the national standards and training content.”

About NEMTAC: The Non Emergency Medical Transportation Accreditation Commission (NEMTAC) was established as a nonprofit organization to enhance and promote the quality of care in America’s non-emergency medical transportation system. NEMTAC standards will represent industry best practices designed to ensure consistently high-quality customer care, safe vehicle operations and ethical business practices. In addition to accreditation, NEMTAC will provide advanced education and training certificate programs to individuals seeking a career in the non-emergency medical transportation industry.

For more information visit www.nemtac.org.

Non Emergency Medical Transportation Accreditation Commission-01
http://www.nemtac.org

Non Emergency Medical Transportation Accreditation Commission (NEMTAC) Announces New Executive Director

Scottsdale, AZ – Non Emergency Medical Transportation Accreditation Commission (NEMTAC) is pleased to announce the selection of Melissa Jankowski as the organization’s Executive Director. NEMTAC is a non-profit healthcare organization dedicated to championing standards and best practices between providers and those in need of non-emergency medical transportation.

“We are thrilled to have Melissa taking on this leadership role as the executive director of NEMTAC,” said Michael Shabkie, Founder and President of NEMTAC. “She brings to the organization an exceptional combination of energy, industry experience and proven leadership.

Melissa started her relationship with NEMTAC earlier this year as the Director of National Standards & Accreditation as she was instrumental in NEMTAC’s application process with American National Standards Institute (ANSI) to become an Accredited Standards Developer.

“I am elated to join NEMTAC and work in partnership with the industry thought leaders who will be the first to work in collaboration to create best practices and standards for the NEMT industry,” says, Ms. Jankowski. “Placing patients at the center of NEMTAC’s standards development is critical to assuring NEMT services are met with quality, timely and safe operations.”

She has worked in the healthcare industry for over 20 years. During this time, she has exceled in managing medical transportation services, hospital consulting services, medical devices, product launch and education. She has extensive experience building relationships in the medical transportation industry, Hospitals and Payors and has provided leadership, mentoring and strategic decision making in these challenging environments.

Melissa holds a BS from Colorado State University and currently lives in Colorado.

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Non Emergency Medical Transportation Accreditation Commission (NEMTAC) was established as a nonprofit organization to enhance and promote the quality of care in America’s medical transportation system. NEMTAC standard represent industry best practices designed to ensure consistently high-quality customer care, safe vehicle operations and ethical business practices. In addition to accreditation, NEMTAC provided advanced education and training certificate programs to individuals seeking a career in the medical transportation industry. For more information visit www.nemtac.org.

Let’s Connect on Linkedin !

#Michael Shabkie is on Linkedin

I’m on a passionate mission to improve the delivery of EMS care by developing integrated healthcare delivery models that accomplishes this simple outcome:

Right Response, Right Treatment, Right Transportation, Right Destination. Each and Every Time! Engage911 – Engage911 Showcase Page

Let’s Connect on Linkedin!

Thinking About Starting a Non Emergency Medical Transportation (NEMT) or Ambulance Company?

Creating a Solid Business Plan is Your Road Map to Success When Starting an NEMT or Ambulance Company – Michael Shabkie

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Developing an Exceptional Ambulance Marketing Program

Originally posted on Michael Shabkie:
Successfully marketing an ambulance company and its’ services is a highly complex undertaking. The sales cycle can be prolonged, the competition fierce and current customers can be fickle. As ambulance company owners or managers, we have to understand our sales process intimately and have a “high touch” marketing plan that…

You’ve got the best ambulance company in the market. You have invested in great equipment, hired competent EMS staff and ordered some pens and notepads. You’re ready to grow, but how do you communicate this to your customers?

The simple answer is to hire a Marketing Associate to go out every day and drum up business. The problem is that there is usually very little time and possibly even less money for training.

Most ambulance companies hire one of their Emergency Medical Technicians or Paramedics to instantly become the “marketing rep” for the company. As you can imagine, this can be a challenge.

The skill set that makes for a great EMS professional is not necessarily the same set of skills that make a great sales person. Are you setting your company and your new Marketing Associate up for failure?

The key to success is to have a formal sales training program. You wouldn’t think of sending an EMT or Paramedic to a 911 call without a comprehensive in-house orientation and clinical training program. Why would you promote an EMT, hand them some pens and send them out to grow your company?

Marketing is a People Business

The first rule of the hiring process is to make sure your Marketing Associate is strong when it comes to the basics. Good communications skills and a genuine interest in meeting people are the golden keys to success.

It sounds simple, but many folks are great in a small personal setting, but freeze up when meeting new people. You can train a person to sell, but it is almost impossible to train a person to be a “people person.”

Selling is about attitude. Is your new Marketing Associate friendly, utterly reliable, and eager to learn?

Sales Training 101

If your company doesn’t have its own in-house training department and you cannot bring in an outside sales consultant, you’ll need to look closely at your staff to develop a sales training program that fits your company’s needs.

You’ll want to identify which of your management team not only has the strongest grasp of what the business goals of company are, but also has the most enthusiasm and interest in your services.

In addition to providing a detailed overview of the services your company offers, the following sales topics should be covered:

·      Mission Statement and goal setting for the next 24 months

·      Organization and time management skills

·      Selling your Ambulance Service line

·      Focus and follow -up with customers

·      Creating the sales pipeline

·      Prospecting and lead generation

·      Dealing with fear in sales

·      Developing presentations that focus on company strengths

·      How to close the deal

·      How to add value during the sales process

·      Relationship building and networking

·      Negotiations 101

As homework, make sure they read at least one good book on sales, for example, the One Minute Salesperson. Discuss with them what they are learning from the book as they read it.

Putting it all Together

After the initial sales training program, you’ll want to test the associate’s grasp of both the technical and sales skills they’ve learned.

Ask them to teach you about the company and evaluate how well they explain the services, their overall level of persuasiveness, friendliness and approachability.

You’ll be looking for an associate that can model the kind of sales behavior that develops relationships, creates a sales pipeline and persuades a decision maker to contract with your company.

Give Refresher Training

Even your best Marketing Associate will move away from the basics the longer they stay in the business.

It’s not at all uncommon to see associates succeed in their first year of business, only to watch them fall into a slump when they get away from the basics.

Much like refresher training for your EMS personnel, make sure there is formal refresher training for the Marketing Associate. Your marketing associate will only be as good or bad as you train them to be.

If you have poor producers, the fault may be in the lack of ongoing training. If it is, correct it. At a minimum, make your marketing associates role-play certain selling situations to strengthen them in the basics.

Final Thoughts

I believe that a marketing associate can know virtually nothing about the ambulance industry, yet still succeed, as long as he or she knows how to sell.

By the same token, I believe that a marketing associate, who knows everything about the industry, but nothing about sales, will eventually starve.

If you start with a simple sales training program and use the previous principles we discussed, I believe you’ll find that your salespeople will function to their maximum efficiency and effectiveness.

About the Author

Michael Shabkie has extensive ambulance business development experience with both the public and private sector. He has also served as a key collaborator for EMS system design, developed winning contracting strategies, managed sales and marketing departments, and acted as an executive advisor on operational processes for both public and private ambulance organizations.

For more information on scheduling the one day marketing boot camp for your ambulance or NEMT sales associates please visit: http://www.engage911.net

Michael Shabkie

Successfully marketing an ambulance company and its’ services is a highly complex undertaking. The sales cycle can be prolonged, the competition fierce and current customers can be fickle. As ambulance company owners or managers, we have to understand our sales process intimately and have a “high touch” marketing plan that is finely tuned for the customer.
High Touch vs. Low Touch Marketing
Let’s compare high touch vs. low touch marketing to see where your ambulance company fits in. For example, how do you shop for a new car? If you are like most consumers, you start searching for various brands and explore car options, visit various car dealerships, take a test drive and after a relatively long research process you finally decide on the car you want to purchase. During this sales process, the dealership has a sales team on hand to actively assist you and can spend hours in…

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