Texas ET3: 5 Things to Know


The Center for Medicare & Medicaid Services (CMS) released its initial list of chosen agencies for their ET3 program. Texas had fifteen selected agencies representing over 40 counties of participation. Here are five things to know about Texas ET3 participation.

1. What Is ET3?

ET3 stands for The Emergency Triage, Treat, and Transport Model. It is a voluntary, five-year CMS payment model exploring a more appropriate use of EMS resources.

The ET3 model involves three areas of intervention: Communications, Transport Destinations, and On-Site Delivery of Care. (See chart for specific details)

In its perfect form, ET3 would reduce the number of EMS responses to 911 calls, enable more appropriate transport destinations, and allow patients to be treated on scene with no additional need for transport.

2. What Kind of Agencies Were Chosen?

Texas had fifteen agencies chosen for participation. Only New York (25), California (21), and Colorado (16) received a larger number of selections.

The fifteen chosen agencies represent a diverse cross-section of Texas EMS delivery models:

Government: Austin-Travis County EMS, MedStar Mobile Healthcare, and Montgomery County Hospital District.
Private: Acadian, Allegiance Mobile Health, AMR, Lifeguard Ambulance Service, and Med-Care EMS.
Nonprofit: UT Health EMS and Willacy County EMS
Fire-Based: Brownsville FD, El Paso FD, Plano FD, and San Antonio FD

They also represent a diverse cross-section of Texas. The counties of participation include Texas’ eight largest metros and portions of its most recognized regions. This creates a considerable sample size of both urban and rural Texas communities.

3. How Will Agencies Implement ET3?

Each agency will release custom ET3 implementation plans in the coming weeks.

The implementation of ET3 involves several significant operational items and logistics. Alternate destinations will need transport agreements, telehealth access may be required for field crews, and advanced practitioner personnel may be need to be hired for new positions.

Each agency’s roll-out will involve innovative solutions customized to their service areas. This will be an exciting activity to observe.

4. What Does this Mean for the EMS Professional?

The biggest takeaway is that EMS is evolving beyond treatment and transport.

ET3 recognizes EMS as a valuable component within the greater US healthcare system. It also recognizes that EMS is a consequential resource in the out-of-hospital environment. Both of these realizations create greater professional potential for the US paramedic.

In an ideal environment, a successful ET3 program would create a career path for paramedics to become physician assistants (PA) or other midlevel providers. This framework can be observed at Austin-Travis County EMS, where they recently integrated a field level PA into their EMS system.

A more common expectation is that EMS professionals will have greater participation in mobile integrated healthcare due to increased responsibilities with healthcare navigation.

5. What Do Legislators Need to Know About ET3?

Legislators need to be informed about the federal evolution of EMS. A better use of EMS resources is predicted to save $560 million per year in Medicare and Medicaid spending, per CMS. This makes EMS a necessary investment for all policy makers.

On the state level, Texas EMS professionals need greater access to education opportunities, increased grant funding for resources, and equal legislative standing with their public safety peers in order to meet the growing needs of their communities.

Federally, Congressional members need to join the Congressional EMS Caucus to stay informed about the evolving needs of EMS. Only two of Texas’ 36 representatives are currently participating in the Congressional EMS Caucus. This leaves a large portion of Texas’ Representatives uninformed about issues facing the EMS profession.

Overall, ET3 is a positive step for the whole of EMS. ATEMSP is excited for our selected agencies and will continue working with legislators to ensure our progress is properly communicated to policy makers.



Association of Texas EMS Professionals

The Association of Texas EMS Professionals (ATEMSP) represents the individual Texas EMS professional. ATEMSP is active in state and federal public policy.