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CMS Efforts Have Missed the Mark

While the country is in the midst of the COVID-19 pandemic, we can’t help but focus on the future of the Center for Medicare Services ET3 model and what the post-pandemic world will look like in regards to ET3 funding.


Curiously, CMS has chosen to use the COVID crisis to fast track one component of the ET3 pilot program. The component they selected was for direct reimbursement for transportation to non-emergency department destinations. While this expansion applies to all medicare ambulance providers regardless of their participation in the ET3 pilot, it misses the point. Many non-emergency locations that were contemplated as alternative destinations have closed their doors or switched to telehealth models during these times. What CMS may have intended as an opening of the floodgates of new transportation destinations for EMS has resulted in a mere trickle in areas hardest hit by the pandemic.


While CMS has effectively progressed past the trial period of ET3 for alternative destination transportation due to the pandemic, the fast-tracking was misguided. The program changes are promising for accelerating groundbreaking change in the emergency medical services industry, but other perhaps more effective features of ET3 have been neglected. Innovators and leaders in this space are left scratching their heads as to what the future holds--will the model regress to the original terms of the trial?; or is alternative destination transportation reimbursement here to stay.


One key element that has not been addressed by this fast-tracking of ET3 is the anticipated funding for 911 nurse triage. Under the pre-pandemic ET3 program, 911 nurse triage was going to be supported by a notice of funding opportunity (NOFO) for ET3 award participants to establish 911 nurse triage centers. This grant funding was contemplated to be a one-time grant funding process to provide funds to establish these 911 nurse triage lines. Yet, there has been no mention of additional funding for 911 nurse triage centers during the COVID outbreak. This is a huge miss by CMS. 911 nurse triage can provide significant amounts of social distancing and provide safe and effective triage of callers without exposing providers, yet CMS has not increased its timeline for granting funds to establish 911 nurse triage centers under ET3.


Unfortunately, even if CMS is to provide these grant funds sooner, this model of funding does not address the needs of jurisdictions to create new nurse triage lines. Programs that have established 911 nurse triage in their communities have expended upwards of $650,000 a year to staff these lines. Ongoing labor costs are the highest cost center in building out a 911 nurse triage line.

The tremendous cost of staffing a nurse triage line in a 911 call center does not align with the grant process that CMS has laid out for the establishment of 911 nurse triage lines. A one time grant does not support the sustained viability of these valuable community resources. This mismatch between the type of funding provided by CMS and the major cost of these programs makes it difficult to stand up a nurse triage line without any prospect of recouping money from CMS for each patient interaction.


Regardless of what CMS decides to do in light of this pandemic, at TruTriage, we aim to provide the most cost-effective solution to establish and maintain an ongoing 911 nurse triage line. Whether under the ET3 NOFO or on a self-funded model, TruTriage’s 911 nurse triage services are available 24/7 remotely from your 911 call center on a cost per call basis. This model significantly reduces the startup cost and ongoing burden of hiring full time or part-time nurses to staff the 911 call center.


TruTriage provides all of the resources necessary to stand-up a nurse triage program in your community in a very short period of time. Our product provides a connection to your call center’s CAD system to share caller data with our nurses and can even link your callers to an UberHealth ride if they need transportation to healthcare resources outside of the emergency system. These features enable communities to start diverting non-emergency 911 calls away from your ambulances to more appropriate destinations for your callers, reducing the surge demand placed on your system and providing better care for your citizens.



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