Medicare program will allow Gold Cross more options for patients

Mar. 3--Autumn Stalvey and Terry Wright see it frequently as they pull up in their Gold Cross EMS ambulance: a 911 call that is not a true emergency that would need hospital treatment.

"We have a lot of cold and flu-type symptoms," said Stalvey, a paramedic.

"Nausea, vomiting, diarrhea," said Wright, an emergency medical technician.

Those less acute patients, and the crew that transports them, then wait a long time in the ER waiting for a room, Stalvey said, "and then they are just passing germs back and forth waiting to be seen."

But soon, Gold Cross crews will have more options for Medicare patients. The ambulance service was one of seven in Georgia, and the only one in the Augusta area, to qualify for the Centers for Medicare & Medicaid Services new program called Emergency Triage, Treat and Transport Model. That now will give ambulance crews three options, said Steven Vincent, vice presidnet for Gold Cross.

"Now, we can still transport them to the hospital, we can transport them to an Urgent Care or we can do a telemedicine visit with a qualified health care professional," he said. As part of its application to join the five-year program, Gold Cross had to spell out its criteria for which patients would be more likely to get which services, Vincent said. The first priority, of course, is to make sure those patients who do need emergency care get it, he said.

"The one extremely important thing for us is we are never going to take someone to an urgent care that needs to go to the hospital," Vincent said. "Our first goal is to triage these patients and to take them to the most appropriate facility."

But by taking people who do not need emergency care to a different venue, it also frees up rooms for those who truly need them, he said.

"Right now, your ERs are so overcrowded because everybody goes to the ER," Vincent said. "Now, this gives a us a choice."

It also provides a way for Gold Cross to treat at the scene when appropriate, either with or without a telemedicine consultation, and still get paid for those services, he said.

Under the old system, "you've treated the patient but you don't have any way of getting reimbursed if they don't go to the hospital," Vincent said.

In addition to getting AU Medical Center, Doctors Hospital of Augusta, and University Hospital on board, Gold Cross also has agreements with University Prompt and Primary Cares, MedNow Urgent Care, and Perfect Health/AU Health System clinics to provide services and transport to those sites, he said.

Anthem Blue Cross Blue Shield is also on board for some of its patients as well as its Medicare Advantage patients, Vincent said, "which is huge because that just opens the door to so many more patients."

Often, the patient would like to avoid the cost of an ambulance ride and hospital visit "but they probably do need to be seen by somebody," he said. This provides a mechanism to do that, for Gold Cross to get paid for it, but without the expense of the ER.

"It's going to be lower cost for the patient and lower cost of the insurance carrier," Vincent said.

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