Treat in place versus transport

Georgia does not write “treat in place.” It writes Treat versus Transport. Alabama put out a Notice of Funding Opportunity called EMS Treat-In-Place. Florida funded a whole category called Preventive Care and Care at Home. Different words, and the differences matter, but underneath them is one mechanic: a patient is somewhere, something is wrong, and the question is whether they get moved.

Every transfer costs somebody. It costs the patient a night away from home, it costs the family a drive, it costs the system an ED visit it did not need, and in rural areas it costs the sending facility a bed and the staff hours to arrange it. So states committed money to reducing transfers, and CMS scores two of its highest weighted factors against it: remote care services and emergency medical services, at 3.75 percent each.

This post is about what delivering it actually takes, because the estimate tends to go wrong the same way every time. The video call is not the hard part. Nobody's project fails at the video call.

Treat in place is worth walking through in detail because it exposes the problem underneath almost every RHTP initiative. A funded capability only works when three things work together: the clinical workflow, the data underneath it, and whether anyone actually uses it. This post is the first of those three. The next two take the other two in turn.

What your state actually committed to

Before anything technical, go read your own state's language. It is public and it is specific.

Georgia's Treat versus Transport work sits under Initiative 5, Leveraging Technology. One caution on Georgia: the dollar figures published against those initiatives are initiative totals split across co-awardees, not one organization's award. If you tell somebody they have a $7 million award and they actually have a share of a $7 million initiative, you get corrected in the first reply and you lose the meeting.

Alabama closed its EMS Treat-In-Place solicitation on 7 August 2026 and awards were pending as I wrote this. Alabama also published the only Year 2 calendar we have found in any state.

Florida placed its entire Year 1 allocation across 81 awards in four regions on 11 and 12 August, including Preventive Care and Care at Home in every region.

The six things that actually have to work

This is the list I would want somebody to hand me before I signed a scope.

• A device and a connection at the point of care. Not a laptop somebody has to go and find. Something mounted, powered and reachable at 3am, in a building where the wifi is honestly described as variable.
• A provider network credentialed in that state. This is the one that quietly sets your schedule, and it is not a software problem.
• Escalation and hand-off. What happens when the remote provider says this person does need to go. Who calls, what travels with them, and what the receiving facility sees before the patient arrives.
• Documentation that survives an audit. The encounter has to produce a defensible clinical note, not a call log.
• Integration back into the record. If the encounter lives only in the vendor's system, the next clinician does not know it happened.
• Measurement that proves the transfer was avoided. Without it you cannot evidence the outcome, and CMS scores initiative-based factors on follow-through.

Look at that list and notice how much of it is not software. Licensure, escalation protocol, documentation standards, and a measurement definition you agreed with your own clinical leadership. The build is the easy half.

Licensure is the schedule risk nobody prices

Here is the practical version. Your remote providers have to be licensed in the state where the patient is. If your program covers one state, fine. If it covers a region, or if you are an aggregator buying on behalf of hospitals in three states, you now have a credentialing project running in parallel with your build, and credentialing does not go faster because you asked nicely.

You have three options and they are all legitimate. Contract a provider group already credentialed where you operate. Use your own clinicians and accept the coverage limits. Or do both, which is where most organizations land: their own people during the day, a partner network overnight and at weekends. Nights and weekends are usually the actual gap, and it is the one staffing cannot close.

What we have run, and what does not carry over

I will be specific about our own numbers here, because the distinction matters more than the marketing.

We built NeverAlone and we still operate it. It supports more than 26,000 patients across 130-plus facilities in seven states, it has carried over 100,000 calls a year for three consecutive years, a resident or staff member reaches a licensed provider in under three minutes, and 96 percent of the time the person is treated in place. Agencies using it have reported readmission reductions of up to 30 percent.

Now the honest part. That 96 percent is measured in post-acute settings. It is not EMS field triage. Those are different clinical decisions, with different medical direction and a different disposition question. If you are running an EMS treat-in-place initiative and somebody quotes you a post-acute number as though it transfers, push back.

What does transfer: on-demand connection to a licensed provider, sub-three-minute response, the documentation layer, device design for people who are not technical, and multi-site operations across facilities with uneven connectivity. Those are the same problems in both settings.

What does not transfer: field triage protocols, medical direction and ambulance disposition. Those belong to your clinical leadership. The right posture from a technology partner is to build to your protocol rather than import someone else's, and anyone telling you otherwise has not sat with an EMS medical director.

The measurement problem, which is really the scoring problem

CMS classifies remote care services and EMS as initiative-based factors, which means the state starts at 50 percent of the available points and earns the rest by implementing and hitting milestones. So somebody has to be able to show that transfers went down.

That means agreeing, before you build, what counts. Which encounters are in the denominator. What a transfer avoided is, and who decides. Whether you are measuring against the same facility's prior year or against a comparison group. This is a twenty-minute conversation at the start of a project and a six-month argument at the end of one.

Here is what delivering it takes. Budget for licensure, escalation, documentation and proof of diversion, and treat the video as the cheap part. Get your measurement definition agreed in week one. And if a vendor quotes you a treat-in-place rate, ask which setting it came from before you put it in a state submission, because a number that reaches a reviewer is effectively certified.

And a treat in place program can have every one of those six things right and still fail, because the encounter never reaches the record and nobody outside the building can see that it happened. That is the next post.