October 26, 2020

Cortez Masto: ACA Brought Lifesaving Innovation to Washoe County, Repealing the Law Could Take Us Backward

Washington, D.C. – U.S. Senator Catherine Cortez Masto (D-Nev.) issued the following statement highlighting the innovative programs the Affordable Care Act has brought to the State of Nevada, including the REMSA Community Health Programs, which created new cost efficient options to help ensure those seeking emergency assistance through 9-1-1 receive the best. This program has been so successful that the Centers for Medicare and Medicaid Services (CMS) has created a national program based on the Washoe County model.

“The Affordable Care Act may be most well-known for providing thousands of Nevadans access to affordable health coverage and ensuring protections for those with preexisting conditions,” said Senator Cortez Masto. “But, the law has also provided the funding for local programs – like the REMSA Community Health Programs – aimed at improving health care delivery and lowering costs. REMSA’s wildly successful program to provide patients who call 9-1-1 with more care options has saved Washoe County more than $10 million and prevented over 6,000 unnecessary or inappropriate Emergency Room visits. These kinds of innovative programs would not have been possible without the Affordable Care Act, and striking down the law will stifle countless more life-saving advances in a time when they are most needed.”

“REMSA is proud to be a part of the communities that we have served since 1986,” said Dean Dow, president and CEO of REMSA. “Innovation has been at the core of this organization since its beginning. We are privileged to be recognized nationally as a leader for providing out-of-hospital healthcare. One of the best examples of that is that CMS is about to execute the launch of ET3. Success and innovation around programs like our interventions intended to reduce costly and unnecessary ambulance transports and emergency room visits, not only impacts the national healthcare picture, but possibly even more importantly has profound importance and directly benefits the local citizens that we serve every day. REMSA continues to work with regional partners, as well as national organizations to ensure we stay at the forefront of healthcare innovation.” 


As part of the Affordable Care Act, Congress allocated $1 billion per decade to test new payment models that improve care quality and access while delivering savings to the health care system, and by extension, taxpayers. In 2012, REMSA – Washoe County’s sole non-profit emergency medical service (EMS) agency – was awarded one of these Health Care Innovation Awards. With the goal of reducing costly and unnecessary ambulance rides and Emergency Room visits, REMSA implemented a three-pronged intervention designed to allow ambulance services in Washoe County to treat patients in need of emergency assistance using the service delivery option suited to their needs, rather than only offering transport to a local emergency room. These options include:

  • Alternative Destination Transport (ADT): This allows ambulances to transport patients to destinations other than emergency departments, like urgent care centers, mental health facilities and detoxification centers.
  • Community Paramedicine (CP): This service offers Washoe County residents seeking emergency care access to specially-trained community paramedics who can provide alternative in-home services in collaboration with referring care coordination teams.
  • Nurse Health Line (NHL): This hotline employs registered nurse navigators to provide 24/7 access to assessment and triage to the appropriate health care or community service.

REMSA’s intervention program achieved $9.66 million in community-wide health care savings over the first four years of implementation, which included the prevention of over 6,000 Emergency Department visits, more than 1,000 ambulance transports, and over 100 hospital readmissions. The program was so successful that it has served as the template for CMS’s new, national Emergency Triage, Treat and Transport Model, or ET3. This model will pay participating ambulance suppliers and providers to provide more flexibility to patients seeking emergency care by allowing ambulances to transport patients to alternative destinations (such as a primary care doctor’s office, a substance abuse center or an urgent care clinic) or provide treatment on the scene with a qualified health care partner.