Pilot fire rescue program uses telemedicine instead of emergency room

Miami-Dade County has executed agreements with Baptist Hospital of Miami and Larkin Health System to create a five-year pilot program to allow the fire department to charge to transport patients with Medicare to urgent care centers and free-standing emergency rooms, and provide telemedicine instead of moving patients to hospital emergency rooms when there is no need to do so.

The Feb. 14 agreements were requested by two resolutions by Commissioner Joe A. Martinez authorizing the mayor to execute the Emergency Triage, Treat, and Transportation Partner Agreements (ET3) among Miami-Dade County, the Miami-Dade Fire Rescue Department, and the hospitals.

Under the pilot program organized by the Federal Agency Centers for Medicare & Medicaid, the agency would pay participating ambulance suppliers and providers to transport patients to a hospital emergency department (ED), an alternative destination such as a primary care doctor’s office or an urgent care clinic or provide treatment in place with a qualified health care practitioner, either on the scene or connected using telehealth.

“The agreement with Baptist is immediately in effect for ET3 transport to all of their urgent care centers,” said Erika Benitez, public information officer of the for Miami-Dade Fire Rescue and Miami-Dade Office of Emergency Management. The agreement with Larkin was also executed, “however, this agreement is still pending approval from the Centers for Medicare & Medicaid Services (CMS), who administers the ET3 program.”

From the time CMS is notified of the executed agreement, it takes about 45 days for them to approve, Ms. Benitez said. The county already has these agreements with UHealth Jackson urgent care centers and Cleveland Clinic.

The program aims to offer county residents new health care options when they call 911 for non-life-threatening medical issues, Ms. Benitez said.

“Instead of being transported to a hospital emergency room, they will have the option to be transported to a partner urgent care center where they can often be treated more quickly and at a much lower cost than a hospital ER,” she said.

The program would also prevent overcrowding emergency rooms with patients that can be treated in other medical facilities, while patients with critical conditions are treated in the hospitals with advanced capabilities.

“The ET3 model aims to improve quality and lower costs by reducing avoidable transports to the ED [emergency department] and unnecessary hospitalizations following those transports,” says the website of the US Department of Health & Human Services.

Once the program is operating fully, the 911 non-emergency patients will also have the option to conduct a telehealth visit with an emergency room doctor while Fire Rescue crews are on scene to assist with vital signs and other medical assessments and treatments, Ms. Benitez told Miami Today.

“Depending on the outcome, the patients may not even need to be transported at all since the doctors are able to provide medical direction and any necessary prescriptions for medication,” she added.

The program intends to optimize the service provided by first responders and would result in “optimal use” of fire rescue 911 frontline units, improve the response time and effectiveness of the services provided to residents, decrease transport-times and distances by allowing units to remain in their district, a memorandum from Chief Public Safety Officer JD Patterson says.

In the same document, Mr. Patterson says the fiscal impact of the agreements is unknown.

Ms. Benitez told the newspaper that currently the majority of ET3 costs are absorbed by CMS since the ET3 program is available only to Medicare patients. “We do not have an exact date yet for the release of fiscal impact information, but we are compiling and reviewing preliminary data from initial pilot operations,” she said.