Emergency Medical Services (EMS) in the United States are at a crossroads. With rising costs, evolving patient needs, and the early termination of the CMS ET3 model, EMS leaders are searching for new ways to deliver care that’s flexible, integrated, and value-driven. The recent whitepaper, “Rethinking EMS Delivery“, authored by PCG’s Chief Ken Riddle, offers a roadmap for the future of EMS that is built on innovation, accountability, and sustainable funding.
Lessons Learned from ET3
The CMS Emergency Triage, Treat, and Transport (ET3) model was designed to reimburse EMS providers for treating patients on scene or transporting them to non-ED destinations. While ET3 ended early due to limited participation and reporting burdens, it sparked a wave of interest in alternative EMS delivery models. What’s interesting in the whitepaper is how ET3’s hurdles helped everyone see what EMS should leave behind, and what new approaches are worth building for the future.
Building Blocks for Scalable EMS Innovation
Chief Riddle identifies three pillars essential for EMS transformation:
- Integrated and Sustainable Funding
Innovative EMS models need diversified funding streams, blending Medicaid, Medicare, Managed Care Organization (MCO) contracts, local government support, and grants. Agencies should pursue Medicaid waivers, pilot program funding, and value-based care partnerships to ensure long-term viability. - Robust Data Infrastructure
Data is the backbone of EMS innovation. Leveraging Computer-Aided Dispatch (CAD), Records Management Systems (RMS), Electronic Patient Care Reports (ePCR), and billing platforms enables agencies to track performance, improve clinical quality, and model finances. Interoperability with hospitals and payers is key for care coordination. - Stakeholder Engagement and Cultural Alignment
No EMS innovation succeeds without buy-in from frontline providers, medical directors, labor partners, and the community. Building trust, transparency, and shared purpose is as critical as operational capacity. Engaging elected officials and educating the public on new care pathways ensures continuity and readiness for change.
Innovative Models Shaping EMS
Treatment-in-Place (TIP)
TIP allows EMS providers to deliver care on scene, often supported by telehealth. This model is effective for low-acuity cases, chronic conditions, and behavioral health stabilization. States like Arizona, Minnesota, Texas, and Washington now reimburse TIP services through Medicaid MCOs. This reflects a growing recognition that EMS can deliver effective care without transport, which helps save costs and improves the patient experience.
Transport to Alternate Destination (TAD)
TAD enables EMS to bring patients to urgent care clinics, detox centers, or behavioral health facilities instead of crowded emergency departments. Arizona, Nevada, and Washington have state-supported TAD programs, demonstrating that EMS can serve as a gateway to broader healthcare systems, not just hospitals.
Mobile Integrated Health / Community Paramedicine (MIH-CP)
MIH and CP introduce a new approach by deploying EMS clinicians alongside nurses, social workers, and primary care providers to deliver preventive, chronic, and post-acute care in the community. These programs reduce 911 calls and ED visits, provide post-hospital follow-up, and connect patients to social services. At least 14 states now reimburse EMS for treatment without transport, and seven states reimburse for community paramedicine under Medicaid.
Why This Matters
The future of EMS lies in flexibility, integration, and accountability. By embracing models like TIP, TAD, and MIH-CP, agencies can deliver care that is patient-centered, cost-effective, and clinically sound. These innovations are more than just ideas. They are already making a difference, with measurable results and real potential for growth. As more states introduce supportive reimbursement policies, it is a good time to pause and consider this question. With all the tools and momentum available, is this the ideal moment to rethink how we deliver EMS care?
Want to dive deeper? Click here to read “Rethinking EMS Delivery“.
About the Author
Chief Ken Riddle serves as Senior Advisor for the Public Safety Consulting Services team at PCG, bringing more than 40 years of experience in fire and EMS operations. Known for his expertise in strategic planning and program implementation, Chief Riddle has led innovative projects like EMS billing systems, firefighter wellness initiatives, and revenue-generating transport services. His data-driven approach has helped agencies nationwide improve performance, compliance, and financial sustainability.
Want to learn more or connect with PCG’s Public Safety team?
Visit https://publicconsultinggroup.com/industry-solutions/health/fire-and-ems-provider-solutions/ or reach out at publicsafetystudy@pcgus.com.
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