Alternative to Medicare-funded ER visits?

The Centers for Medicare and Medicaid Services (CMS)—the agency that oversees the Medicare program—sees a way to help people with Medicare avoid unnecessary trips to hospital emergency rooms.

CMS officials said the new voluntary, five-year payment model they announced in February would allow ambulances or aid vehicles to take individuals to their primary care doctor or urgent care, or to deliver treatment in place when the person doesnt need to be seen in an emergency room.

Currently, most emergency transportation after a 9-1-1 call is limited to taking the patient to a hospital. That can expose Medicare beneficiaries to the expense and stress of an emergency room visit when they may really need to see their doctor or receive limited treatment at home, according to CMS. The new approach would allow participating ambulance services to partner with providers to deliver treatment in place when appropriate, either on-the-scene or through telehealth.

In a statement, Medicare Rights, a citizen advocacy organization, said CMS must ensure that people with Medicare receive appropriate care when they face a medical emergency.

“We welcome efforts to keep people out of the emergency department when safe and feasible, though we cannot be sure yet if this model will have the necessary safeguards,” Medicare Rights said.

Currently, Medicare regulations only allow payment for emergency ground ambulances when patients are transported to hospitals, skilled-nursing facilities, and dialysis centers. Most beneficiaries who call 9-1-1 with a medical emergency are transported to such facilities, and most often to a hospital ER, even when a different destination may meet an individual’s needs better.