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Value Proposition As telemedicine practices are increasingly adopted across the Nation in EMS and 911 services, the benefits of this emerging approach to healthcare delivery have become more apparent. In summary, telemedicine for EMS and 911 organizations may improve patient outcomes, enhance the patient experience, and reduce the per capita cost of health care. For EMS and 911 organizations interested in establishing a telemedicine program, capturing these benefits in a value proposition will help bring administrators and partners on board. Examples of the value telemedicine can provide for different healthcare stakeholders include: • Patients: rapid access to care, enhanced understanding of care options and delivery, real-time interaction with known or specialized healthcare providers, reduced healthcare bills • Community: improved overall health of populations, reduction in burden of healthcare costs • EMS system: increased efficiency, real-time consultation with remote physicians, improved patient experience and outcomes, enhanced integration with healthcare system, improved relationships with hospitals, diversified revenue streams, increased patient and practitioner safety, enhanced decision making, reduced vehicle crashes and wear • 911 system: increased efficiency, enhanced integration into the overall healthcare system, improved situational awareness, enhanced decision making, better understanding of patient outcomes • Overall healthcare system: increased efficiency, integrated systems of care, lower overall costs In the context of COVID-19, telemedicine offers EMS and 911 organizations wider opportunities to provide and facilitate healthcare services to the communities in which they serve. Throughout 2020, EMS activations varied considerably compared to previous years, according to the National Emergency Medical Services Information System (NEMSIS) and shown in Figure 1. 4 While points of the pandemic showed overall high numbers of activations compared to previous years, the total activations dropped significantly during heightened periods of COVID-19 lockdown (e.g., in the spring of 2020 and the winter of 2020-2021). Alignment with EMS Agenda 2050 Building on the foundation laid by the 1996 EMS Agenda for the Future, EMS Agenda 2050 was developed through a multi-year initiative that established a vision of people-centered EMS and 911 systems. The document articulates a bold plan for innovative, people-centered possibilities to advance EMS systems. A key component was to foster models for systems that account for changes in social needs, including new reimbursement models. Establishing and implementing telemedicine programs for EMS and 911 systems follows that purpose. The six guiding principles of EMS Agenda 2050 This resource document has been developed to support those guiding principles. Inherently safe and effective a. Providing high quality care without in-person interactions b. Benefit: reduction of response crashes, reduction of emergency motor vehicle crashes and risks, elimination of lights and sirens use • Integrated and seamless a. Incorporating various data sources, increasing connectivity with providers, and coordinating care across jurisdictions a. Benefit: easily adapt to the out-of-hospital workflows and environments • Reliable and prepared a. Routine, effective telemedicine interactions and effectively adapting to challenges b. Benefit: new technologies such as FirstNet and satellite broadband enable capabilities regardless of location • Socially equitable a. Providing telemedicine care appropriate for urban and rural areas, cognizant of the needs of different patient populations • Sustainable and efficient a. Establishing new reimbursement models and maintaining effectiveness without hospital transport a. Benefit: lower cost per visit, elimination of inappropriate utilization, lower emissions, lower wear and tear on equipment • Adaptable and innovative a. Developing new methods for delivering healthcare services b. Benefit: rapidly overcome care delivery challenges to unforeseen events (e.g., telemedicine has been used for this purpose during the COVID-19 pandemic) ET3 MODEL Relationship with the Emergency Triage, Treat, and Transport Model Medicare regulations have historically only allowed payment for emergency ground ambulance services when individuals are transported to hospitals or critical access hospitals, with non-emergency payments for transportation to skilled nursing facilities, dialysis centers, and home when deemed medically appropriate. Most beneficiaries who call 911 with a medical emergency are therefore transported only to a hospital emergency department, even when a lower-acuity destination or no need for transportation may more appropriately meet an individual’s clinical care needs. Emergency Triage, Treat, and Transport (ET3) is a CMS Center for Medicare and Medicaid Innovation (CMMI) voluntary, five-year payment model implemented on January 1, 2021 that intends to provide greater flexibility to ambulance care teams and 911 centers to address the emergency health care needs of Medicare fee-forservice beneficiaries during and following a 911 call. CMS will continue to pay to transport a Medicare fee-forservice beneficiary to a hospital emergency department or other covered destination. In addition, under the model, CMS will pay participants to 1) transport to an alternative destination partner, such as a primary care office, urgent care clinic, or a community mental health center (CMHC), or 2) initiate and facilitate treatment in place with a qualified health care partner, either at the scene of the 911 emergency or via telemedicine. CMS issued a Notice of Funding Opportunity (NOFO) in March 2021 to seek applications for the medical triage line intervention of the ET3 Model. Through a competitive process, up to 40 two-year cooperative agreements may be awarded to eligible entities (e.g., local governments, their designees, or other entities) that operate or have authority over one or more 911 call centers in geographic locations where ambulance suppliers and providers have been selected to participate in the ET3 Model. The ET3 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 centers to promote successful model implementation by establishing a medical triage line (or establishing a partnership with a medical triage provider) 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.