February 20, 2024

ACEP Provides Feedback on CMS Boarding Measure

The Centers for Medicare and Medicaid Services (CMS) is working on a new measure to track boarding in the emergency department. ACEP members are involved in the process and ACEP has now shared formal comments with CMS to inform its development.

The Equity of Emergency Care Capacity and Quality (ECCQ) Electronic Clinical Quality Measure (eCQM) would gauge emergency care capacity and quality to support hospital quality improvement by tracking the proportion of emergency department visits that meet at least one of four outcomes:

  • The patient waited longer than 1 hour to be placed in a treatment space in the ED.
  • The encounter ended without the patient undergoing a completed medical screening examination (MSE) by qualified medical personnel (QMP).
  • The patient boarded (time from admission order to patient departure from the ED for admitted patients) in the ED for longer than 4 hours.
  • The patient had an ED length of stay (LOS) (time from ED arrival to ED departure) of longer than 8 hours.

“Measurement is essential to identifying, diagnosing, and solving the complex boarding problem. Unfortunately, our ability to measure this problem is severely limited,” ACEP wrote.

CMS recently eliminated the measure to capture admit decision time to ED departure time for admitted patients. ACEP strongly opposed its removal because it was one of the only measures that specifically captured ED boarding. CMS also proposed to eliminate the Left Without Being Seen (LWBS) measure. ACEP strongly opposed its removal and was pleased when CMS reversed course to keep it in place.

ACEP comments on the coming measure emphasize that ED boarding and crowding are not caused by ED operational issues or inefficiency; rather, they stem from broad health system dysfunction.

Measures can help reinforce the risks associated with boarding and underscore the urgent need for solutions. In fact, a substantive body of research connects boarding to negative patient outcomes, ambulance diversion, increased adverse events, preventable medical errors, lower patient satisfaction, violence in the ED, emergency physician and staff burnout, and higher overall health care costs.

ACEPs comments are part of a comprehensive advocacy campaign to address boarding in the emergency department. Systemwide challenges require collaborative solutions and ACEP is making sure that emergency physicians are heard and leading the way forward.


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