Tennessee Develops EMS Response Program for Low-Acuity Medicaid Patients
By Dorothy Brooks
Tennessee lawmakers have approved the Triage, Navigate, Treat, and Transport (TN-T2) program for that state’s Medicaid program, TennCare.
The TN-T2 program is built on the same principles as ET3, according to Tony Anteau, mid-states regional president for Priority Ambulance, a company that runs EMS operations in 13 states, including Tennessee. “Members of our staff worked closely with other emergency medical care organizations to shepherd the state legislation [in Tennessee],” he explains. “The goal of the program is to provide person-centered care, increase efficiency in the emergency medical services system, and encourage appropriate utilization of services.”
Anteau says TN-T2 administrators are trying to shift the paradigm of EMS delivery for the TennCare population to ensure patients receive the correct care when and where they need it. “As an added benefit, the program, once implemented statewide, is estimated to reduce unnecessary visits to the ED, ease crowding of emergency medical services, and generate more than $8 million annually in TennCare savings,” Anteau says.
When an ambulance arrives on the scene of a 911 call, EMS providers follow existing protocol to determine the level of required care. “The patient is first triaged by our highly trained first responders who are experienced in identifying life-threatening medical needs and stabilizing patients,” Anteau explains. “The ambulance crew is supported by online medical control at the hospital or the ED to assist in prescribing emergency care to the patient.”
If EMS determines the patient does not require ED care, he or she may be offered a telemedicine visit with a physician or nurse practitioner. “Depending on the diagnosis, the patient may then opt to be treated on site or to be transported to an alternative destination partner like an urgent care clinic, Federally Qualified Health Center, or a Community Mental Health Center. The patient may also refuse these options and still be transported to the ED.”
These options allow EMS to deliver appropriate care to TennCare patients, and enable qualified first responders, including 911 ambulance service agencies and fire departments, to receive reimbursement for calls treated outside the hospital.
While the TN-T2 program has required additional staff training, Anteau notes prehospital providers are accustomed to receiving continuous education to stay up to date on the latest best practices in emergency care. “Everyone has been incredibly receptive to this program, both because it improves the system of care and reduces burden on EDs and provides better options for the TennCare patients who are located in areas where it is traditionally difficult to provide care,” Anteau says. “We’ve begun our rollout in rural counties where our patients and providers are spread out geographically.”
Once TN-T2 is fully implemented, program administrators expect the program to alleviate ED crowding, improve transport wait times, and ease the strain on emergency medical care across the board.
“Partners across the Tennessee healthcare industry, from first responders to insurance providers, are working together to think outside the box,” Anteau says. “We would encourage our colleagues in other communities to consider doing the same. The model of empowering the correct resources to [provide] care for the community is one that we see beginning to be employed nationwide, to creatively solve the challenges facing the emergency medical industry.”
The program, modeled after ET3, once implemented statewide, is estimated to reduce unnecessary visits to the ED, ease crowding of emergency medical services, and generate more than $8 million annually in Tennessee Medicaid program savings.
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