Recently, the U.S. Department of Health and Human Services (HHS) and the Centers for Medicare & Medicaid Services (CMS) released new guidance and regulatory requirements for all hospitals to report specific COVID-19 information related to testing, capacity and utilization, and patient flows. HHS is requesting the information to help inform its ongoing efforts to respond to the pandemic. CMS, in turn, is responsible for enforcing the reporting requirements.
Hospitals are required to report most of the requested information on a daily basis. However, HHS is continuing to modify the requirements, making some of the data optional for reporting and requiring other data to be reported once a week instead of daily to reduce overall reporting burden. In all, the list of items on which hospitals must report is long and includes some specific provisions related to emergency department (ED) use:
- ED/overflow: Patients with suspected or laboratory-confirmed COVID-19 who currently are in the ED or any overflow location awaiting an inpatient bed.
- ED/overflow and ventilated: Patients with suspected or laboratory-confirmed COVID-19 who currently are in the ED or any overflow location awaiting an inpatient bed and on a mechanical ventilator. This is a subset of the above item.
- Previous day’s total ED visits: The total number of ED visits in which the patient was seen on the previous calendar day regardless of reason for visit (including all patients who are triaged even if they leave before being seen by a provider).
- Previous day’s total COVID19-related ED visits: The total number of ED visits in which the patient was seen on the previous calendar day who had a visit related to COVID-19 (meets suspected or confirmed definition or presents for COVID diagnostic testing. This does not include patients who present for pre-procedure screening).
HHS has hosted a series of webinars to address hospitals’ specific technical questions about the reporting requirements. The next webinar is today, October 22, at 1 pm EST.
Besides the reporting requirements themselves, what is also getting a lot of attention is CMS’ strict enforcement strategy. CMS has laid out a 14-week long, step-by-step, enforcement process for non-compliance, including sending out multiple notification letters to individual hospitals that continually fail to report this information. And what happens at the end of the 14 weeks if hospitals continue to fail to report data? Well, CMS will enforce the harshest penalty it can think of—possible removal from the Medicare program.
CMS’ use of a sharp stick to drive compliance during a pandemic is not sitting well with some. The American Hospital Association opposes this strict policy, calling it “an overly heavy-handed approach that could jeopardize access to hospital care for all Americans.” As the pandemic rages on, it will be interesting to see if any hospitals repeatedly fail to report this information, and if so, whether CMS decides to follow-through and kick these hospitals out of the Medicare program. I believe small hospitals and those located in rural areas are at the biggest risk of not being able to meet the reporting requirements. One recent study conducted by the Center for Healthcare Quality and Payment Reform found that over 800 rural hospitals—comprising 40 percent of all rural hospitals in the country—are at risk of closing in the near future. When a hospital closes, mortality rates and readmission rates increase at nearby hospitals, particularly at high-occupancy bystander hospitals that are sensitive to changes in the availability of emergency care in neighboring communities. Thus, removing any hospital from the Medicare program could definitely have a detrimental impact on patient care—which is not what we want during a pandemic!
Before concluding, I want to remind all of you that ACEP20—ACEP’s major annual conference—is next week! This year, we are having an unconventional, virtual meeting, reflecting the extraordinary times we are living in. You can register here!
Some highlights of the meeting are below—you won’t want to miss it!
- 250+ CME hours of live and on-demand education you can access for 3 years! And for just $1.80 per CME hour, ACEP20 provides unprecedented value for your education dollars!
- Over 175 speakers from around the world
- 200+ abstracts presented in our Research Forum
- 13 COVID-19 specific courses with the most up-to-date information
- Anthony S. Fauci, MD, providing perspective from the epicenter of the COVID crisis
- Ibram X. Kendi, PhD, joining our panel discussion about health equities and where we go from here
- Laurie Santos, PhD, digging deep into the science of happiness and wellbeing.
- Catch up with your friends: All attendees have their own personal video chat rooms so you can invite friends to chat between courses.
- Mix & Mingle: The first 25 to join these happy hours get to chat with different EM luminaries each night while whipping up a DIY cocktail.
- Guac with a Doc: Dip into Dallas cuisine from wherever you are as a local chef leads a quick cooking & cocktail demo.
- Pick your poison: Do you want to win the Trivia Night, Knowledge Bowl or Fortnite Tourney? Or are you going for the trifecta? Let your competitive side shine!
- Reflect on this year: Take part in the Theater of War for the Emergency Medicine Community or join the personal sharing event Smores & Storytelling. Talk about the year's challenges with your peers who get it.
Until next week, this is Jeffrey saying, enjoy reading regs with your eggs!