Upper Pine River Fire Protection District joined a selective pilot program that will change how it offers ambulance services to Medicare patients in its 265-square-mile district.
Ambulance providers often take patients to emergency departments or other critical facilities, even with non-critical health issues, because of current Medicare regulations. The pilot program aims to change that practice. Through the program, Upper Pine patients will have more transport options, and health costs could be reduced systemwide.
“Right now, the ambulance only gets reimbursed if it takes somebody to an emergency room,” said Bruce Evans, Upper Pine fire chief. “What this program allows Upper Pine units to do is to take people to alternative destinations.”
Currently, Medicare regulations allow payment for ambulance services only when patients are transported to hospitals, critical-access hospitals, skilled nursing facilities and dialysis centers. Most end up going to a hospital emergency department, according to the Centers for Medicare and Medicaid Services, which manages the pilot project.
But care in emergency rooms is more expensive than other options, Evans said. That increases the cost of care for providers, burdens emergency departments and adds expenses for patients.
The Emergency Triage, Treat and Transport (ET3) pilot payment model would allow payment for ambulance services that transport patients to primary care offices, urgent care facilities and at-home telemedicine care.
It applies to Medicare Fee-for-All beneficiaries only, not Medicaid or Medicare Advanced beneficiaries.
“As soon as Medicare opened this up, we’re now having private insurance talking about doing the same thing,” Evans said.
The pilot’s payment structure could mean $75,000 to $125,000 each year being returned to Upper Pine’s ambulance budget, he said.
About 30% of residents in the district in eastern La Plata and western Archuleta counties are on Medicare. Of all the district’s ambulance calls, about 45% do not require transport, which Medicare would pay for as part of the pilot program, Evans said.
The funds would support the Community Paramedic Program, which is designed to keep seniors in their homes longer and fill emergency care gaps.
Upper Pine is finalizing agreements with alternative transport locations, like Durango Urgent Care, and working with Mercy Regional Medical Center to expand its telehealth capabilities.
Agencies from 36 states and the District of Columbia applied to be part of the pilot program. In Colorado, the program selected 12 ambulance service providers, working in 20 counties.
Upper Pine worked with agencies in Eagle, Delta and Ute Pass in central Colorado to align their services during the application process.
“I think that was key in all of us being successful in getting into the pilot program,” Evans said.
smullane@durangoherald.com
