⚠ PRELIMINARY: NOT FOR PUBLIC USE: These models are unfinished and calculations have not been verified or finalized. They are intended solely for internal discussion purposes. Data and outputs may be inaccurate or incomplete. These models do not represent a policy position, recommendation, or official stance of NCRETAC, its board members, volunteers, or staff.
EMS Sustainability Task Force — Phase IV | Funding Workgroup
TIP & TAD Savings Potential
Models the financial impact of Treatment in Place and Transport to Alternative Destination. ED conversion default = 100% (reduce for conservative patient-mix estimates). Baseline gap: $95.5M.
Annual 911 Responses
758,327
CO ePCR 2023-24
Urban Calls
658,327
where diversion cost savings are achievable
Rural + Frontier Calls
99,569
geography-bound — care delivery benefit only
Structural Gap
$96M–$433M
current ops to full desert remediation
ED Conversion Default
100%
reduce for conservative patient-mix estimates
Scenario Presets
Select a scenario or adjust sliders below. Scenarios reflect realistic adoption trajectories based on ET3 experience and state program literature.
Diversion Parameters
Urban & Suburban (658,758 calls/yr)
TIP/TAD diversion rate
10%
% of urban 911 calls resolved without ED transport (35% ceiling — TIP/TAD literature)
Cost savings run
Rural & Frontier (99,569 calls/yr)
TIP/TAD diversion rate
5%
Geography-bound: minimal cost savings regardless of diversion (25% ceiling)
Program & Reimbursement
TIP/TAD program cost
$325
Cost per encounter: staff time, protocols, medical oversight, documentation
Value-based contract rate
$0
State / payer reimbursement per TIP/TAD encounter ($0 = no VBC enacted)
Rural/frontier VBC rate
$0
Separate rural rate — geographic equity requires explicit rural weighting
ED Cost Parameters
ED visit cost avoided
$2,200
Average ED visit cost (HCUP 2022 baseline). Savings accrue to payers.
ED conversion rate
100%
% of diverted calls that would otherwise have been ED transports (default 100% = maximum savings estimate; reduce if patient mix skews lower-acuity)
Net Impact on EMS Structural Gap
Change to Annual EMS Structural Gap
—
—
EMS Revenue Lost
—
Lost transport billing
EMS Cost Saved
—
Staffing / unit reduction
Program Cost
—
TIP/TAD operations
VBC Revenue
—
State / payer contracts
Adjust sliders to model TIP/TAD impact.
System Savings (Payers & Hospitals)
ED Direct Savings
—
Medicare / Medicaid / commercial
Downstream Savings
—
Hospitalization risk reduction
Total System Savings (not EMS)
—
Accrues to payers & hospitals — not to EMS agencies without VBC
System savings accrue to Medicare, Medicaid, and commercial insurers — not to the EMS agencies producing them. Without a value-based contract, every diverted transport widens the EMS structural gap.
Urban vs. Rural/Frontier Economics
Urban variable cost fraction: 45% (short-run) / 60% (medium) / 80% (long). Rural/Frontier: geography-bound — cost floor does not move with call volume. Average APCD revenue: Urban $867/call, Rural $942/call, Frontier $1,061/call. Source: APCD revenue model, CCECBI v1.0.
Scenario Comparison — Net EMS Gap Impact at Scale
How to read this chart
What you seeEach bar pair shows the net effect on the EMS structural gap at a given urban TIP/TAD diversion rate — what percentage of urban 911 calls are resolved without transporting the patient to an emergency department. Green bars mean the gap narrows (EMS is better off); red bars mean the gap widens (EMS is worse off). The left bar in each pair shows the result without any value-based contract; the right bar (if shown) includes VBC payments.
What it meansWithout value-based contracts, every bar is red — every level of diversion makes the EMS funding problem worse, not better. That is because EMS loses the transport billing revenue while the system savings flow to Medicare and commercial insurers, not to EMS agencies. Only when VBC payments are set at or above the break-even rate do the bars turn green.
What this means for policy: TIP and TAD are good patient care. They reduce unnecessary ED visits and save payers money. But they worsen the EMS funding gap unless the legislature creates a value-based contract framework that returns a share of those savings to EMS agencies. Without that, EMS is being asked to absorb costs that benefit everyone else's budget.
Each bar shows net change to EMS structural gap at the indicated urban diversion rate, holding rural at 5%, medium-run cost savings, program cost $325/encounter. Green = gap narrows. Red = gap widens. Values assume current gap method (GADCS). VBC line shows the rate per encounter needed to break even at each diversion level.
Legislative Design Implications
Urban Systems
TIP/TAD can generate genuine EMS cost savings at sustained diversion rates above 15–20%, once unit reduction becomes operationally feasible. Savings are real but only materialize in the medium-to-long run. Value-based contracts accelerate the break-even timeline significantly.
Rural & Frontier Systems
Geography-bound counties must maintain staffed units regardless of call volume. TIP/TAD in these areas is a care delivery benefit, not a cost reduction tool. State funding must flow to rural/frontier TIP programs directly — it cannot be funded from efficiency savings that do not materialize in fixed-cost systems.
Value-Based Contracts
Without VBC, TIP/TAD widens the EMS gap in every scenario. System savings of $— accrue to payers. A state VBC framework that returns even a portion of those savings to EMS agencies is the single most impactful policy lever available to the General Assembly.
Geographic Equity Requirement
Any TIP/TAD reimbursement program must include explicit rural and frontier weighting. Urban systems benefit from cost reduction; rural/frontier do not. Without deliberate geographic design, reimbursement flows to already better-resourced urban agencies.