New model gives patients better care, emergency responders more options

Until recently, when Gundersen Tri-State Ambulance was paged to transport a distressed person to the hospital, it would automatically drive to the appropriate emergency room in La Crosse, regardless of the person’s level of trauma.

But now, a new Centers of Medicare and Medicaid Services (CMS) model that allows the ambulance service to assess medical needs at the scene aims to direct patients to the facility that best meets their immediate needs – be it the emergency department, urgent care or other destination that’s covered under Medicare.

New model provides new options

The Emergency, Triage, Treat and Transport, or ET3, Model gives Tri-State paramedics more flexibility when addressing a patient’s condition following a 9-1-1 call. That flexibility pairs patients with the appropriate level of care at the right time and place, which many times may not be the emergency room.

“I think a common misconception in 9-1-1 care is that everyone who calls 9-1-1 is a really, really sick patient, they need an ambulance, they need this high-level care, and they have to go to the emergency room,” said Evan Weis, the program manager for Gundersen Tri-State Ambulance. “The reality is that often times, they just can’t access care in any other way. … We’re kind of the catch-all for healthcare that will always show up for you.”

In the past, ambulance services like Tri-State would be reimbursed by Medicare for taking patients to the emergency room – and only the emergency room. Now, that model has shifted to include other medical facilities that are deemed the most appropriate for each patient.

Providers on scene virtually

That determination, however, isn’t left to just the paramedics at the scene. As part of the program, Tri-State ambulances are now equipped with portable monitors that allow medics to connect virtually with providers at the hospital to do an initial assessment. That, Weis said, could result in a patient not even needing transport.

What’s more, as part of a multi-payer strategy, CMS provided the latitude for Gundersen Tri-State Ambulance to partner with and expand these care options to all payers, such as those on a Quartz insurance plan, and not just those enrolled in Medicare.

“That could represent a significant cost savings if they don’t need to be seen in the ER and could be treated effectively through this other channel,” Weis said, adding that patients will be taken to whatever appropriate facility they choose within their network, regardless of affiliation.

A rare model of care

There are only a handful of ambulance services in the state that have signed an agreement to participate in the ET3 Model, and Gundersen Tri-State Ambulance is the only one in western Wisconsin. Not only does it provide patients options to fit their needs, but it changes the way paramedics do their work, especially with the telehealth component.

“It’s probably the biggest shift in the EMS industry in its history,” Weis said. “Having that capability, being able to leverage that video and extend that service … to the paramedics – who are already highly skilled and trained – adds that extra layer of knowledge and ability to access providers in the ER. We can potentially improve patient outcomes very significantly, especially with time-sensitive interventions.”

And Gundersen Tri-State Ambulance is taking its program one step further, as it’s currently working with Gundersen’s cardiology and pediatric departments to see how it might further leverage the telehealth services it can provide, beyond what the ET3 Model enables.

All that, Weis said, can add up to a better outcome for each person who finds themselves in need of critical, sometimes lifesaving care.

“Now we can partner with them in their healthcare, to get them the right level of care, to get them affordable care, if that’s a concern for them,” he said.