South Florida Hospital News
Thursday February 27, 2020

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May 2019 - Volume 15 - Issue 11




Not Everyone Who Calls 911 Needs to Go to the ER

Medicare is proposing to implement a new program called Emergency Triage, Treat and Transport, or ET3. The idea is to determine whether a person who calls the 911 emergency line can be taken to a more suitable place than automatically being sent to an emergency room. Matt Johnson, general manager of Century Ambulance Service, explained the patients could be going to different locations that are more appropriate – even the patient's physician's office, if they could handle the patient. Medicare will pay for them to be transported to an urgent care center that accepts Medicare so they can get treated at a lower price, or even be treated on-scene. Medicare would save money because not everyone will be going to the hospital for treatment.

Applications to participate in the model are expected to be released in a few months, and Johnson said that while everything is just being proposed at this point, his company is considering applying. "They announced it earlier this year but not all of the details are out yet, we will have more specifics this summer." He added, "In the past, whenever someone would call 911, the only option for whoever was going to transport them was to send them to an emergency room that was attached to a hospital. But not everyone who calls 911 needs an ER with all of its resources and price."
As an example, Johnson pointed out that previously, someone with a sprained ankle who called 911 would have automatically been taken to an emergency room, when a trip to an urgent care center would have been sufficient. "Now you can take them to urgent care. It's a big paradigm shift in the way emergency care in the field has been treated in the past. Before, you were just picked up and taken to the hospital and somebody would get reimbursed for taking you to the ER. Now it's changing because you can transport the person to the most appropriate location." However, he added that if the person insists on going to the ER, they will be taken there. "Yes, absolutely. None of this trumps the patient's choice."
Because of the potential importance of this program, Johnson believes Century Ambulance should seek to be a part of it. "As a large ambulance provider in the state of Florida, I think it's important for us to participate in this program because it is the direction that health care is heading – providing more appropriate care where it's not so expensive and when it's not necessary. It's reshaping the direction of the way pre-hospital emergency care is being delivered. We want to help drive that change as a positive thing, so it just makes sense to be a part of it."
In addition, Johnson believes the idea behind the program will be effective, calling it a step in the right direction. "Twenty years from now, will it look like it will next year? Probably not. It will evolve, but I believe it's the right type of evolution to occur." He said people in the pre-hospital fields have known for a long time that for many of the transports they do, the patients don't need to go to the ER. "But transporting them to the ER was basically the only choice."
Another recent, front-line aspect of medicine that could be incorporated into the care is telemedicine, which Johnson said is a means of bringing the hospital to patients in the field. Telemedicine has become a big part of health care, with monitors being brought in and doctors video-streaming and speaking to patients. He said part of the ET3 model allows for this. "Somebody might be experiencing something that they perceive to be an emergency, but telemedicine can be used on-scene to help diagnose whether the ER is appropriate; or perhaps they should go to an urgent care or see the family physician, and both the family physician and the EMS providers will be reimbursed for the service. It's a whole new level of care that could be administered in the field that really hadn't been done in the past. If you think about it, it's kind of like a modern version of a doctor making a house visit."
In summarizing Medicare's proposed ET3 program, Johnson said, "It allows us to take the patient to a more appropriate location for more appropriate care at the right price. Ideally, at the end of the day, Medicare believes it will reduce the amount of money it will spend on people going to the ER."

For more information, call (905) 356-0835 or visit

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