Bamboo Health recently hosted a webinar for hospital executives and providers on the new e-notifications Condition of Participation (CoP) requirement that the Centers of Medicare and Medicaid Services (CMS) published on May 1, 2020, in the Federal Register.

Under the new CoP, hospitals, psychiatric hospitals, and Critical Access Hospitals must send real-time ADT-based e-notifications to patients’ established practitioners, practice groups and entities, and post-acute providers and suppliers.

Both during and after the webinar, our team received several important questions from hospital CIOs and heads of compliance about the specific requirement details, and what it will take for them to achieve compliance by the May 1, 2021 deadline. Below are ten critical questions answered by our team to help support hospital executive teams as they navigate this new requirement.

1. HOW IS “REAL-TIME” FOR SENDING NOTIFICATIONS DEFINED IN THE FINAL CMS? IS THERE A SPECIFIC TIMEFRAME (E.G. 24 HOURS) THAT CMS SPECIFIES?

Hospitals are required to send e-notifications at the time of a patient’s inpatient admission, discharge, and transfer event and at emergency department presentation/registration and discharge. CMS was deliberate in requiring e-notifications be sent in real time, i.e. “at the time of” an event occurring.  Real-time delivery of the e-notification not only eliminates information delays and improves current information sharing practices, but also guarantees the information is actionable, which maximizes care coordination opportunities across the care continuum and improves patient outcomes. An e-notification delay lasting hours or days or sending batched e-notifications will not meet the rule requirements to send notifications “at the time of” events occurring.

2. IS THERE A LIMIT ON THE NUMBER OF PROVIDERS A PATIENT CAN HAVE THEIR DISCHARGE INFORMATION SENT TO BY THE HOSPITAL?

The only limitation is that notifications need to be sent to practitioners, practice groups or entities, and applicable post-acute care providers and suppliers that have an established care relationship with the patient and that need the information for treatment, care coordination, or quality improvement activities. Therefore, the number of e-notification recipients will vary by the number of providers a patient has and there is no prescribed limit. Of course, a patient is able to specify their data sharing preferences and hospitals or their intermediaries must send e-notifications in a manner that is consistent with those privacy preferences and with all applicable federal and state laws and regulations.

3. WILL HOSPITALS THAT ALREADY SEND THEIR ADT FEEDS TO HIES BE AUTOMATICALLY COMPLIANT WITH THE COP?

Compliance will depend on whether the HIE, as the hospital’s intermediary, can fulfill the minimum requirements specified within the final rule. Those requirements include the ability to send e-notifications:

  • For all required patient events – inpatient admissions, discharges and transfer events as well as for emergency department presentation/registration and discharge events
  • In real time – at the time of admission, presentation/registration, discharge, and transfer
  • Including, at minimum, patient name, treating practitioner name, and sending institution name
  • To the practitioners, practice groups or entities, and post-acute providers and suppliers identified directly by patients and that are not otherwise fulfilled through a hospital’s existing technology solution
  • To the established primary care practitioners, established primary care practice groups or entities, and applicable post-acute providers and suppliers that have an active care relationship with the patient and request information for treatment care coordination, or quality improvement activities irrespective of geographic location
  • Consistent with patients’ privacy preferences – no e-notifications must be sent for patients that do not want their information to be shared
  • To recipients that have required data sharing agreements in place and consistent with all applicable federal and state laws and regulations.

In addition, to minimize any potential security incidents and inaccurate notifications, a high accuracy match rate should be in place to ensure notifications are sent to the appropriate providers.  Any intermediary, including HIEs, should have capabilities to frequently update provider-patient care relationships given they often change, especially in the post-acute setting.

Ultimately, hospitals are accountable to meet compliance requirements even when they delegate the e-notification functions to HIEs or other intermediaries and should therefore ensure that all minimum requirements are met.

4. WHAT IS THE PENALTY FOR NON-COMPLIANCE WITH THE NEW COP REQUIREMENT?

Conditions of Participation are the most significant and consequential regulatory lever that CMS has to authorize or terminate a hospital’s certification. CMS certification determines whether hospitals can receive Medicare and Medicaid payments, which often make up more than 50% of a hospital’s payer mix. To receive or maintain certification, hospitals must meet all CoPs, making compliance with CoP standards and conditions essential to hospital operations.

If deficiencies in complying with the e-notification CoP are found during the survey process, those deficiencies will be formally documented by the survey team on the CMS “Statement of Deficiencies and Plan of Correction” form and hospitals must follow time-bound processes to correct them. Unless hospitals remediate deficiencies, termination of CMS certification will go into effect after a maximum of 90 days.

5. HOW WOULD POST-ACUTES OR PCPS RESPOND TO A NOTIFICATION? CAN THEY SEND A REPLY TO THE HOSPITAL SYSTEM?

There is no prescribed way or method for post-acutes or PCPs to respond to e-notifications they receive from hospitals. CMS also does not require a “read receipt” from e-notification recipients.  However, the goals of the CoP are for recipients to use the information to support their care coordination efforts, enhance communication across the care continuum and thereby improve patient outcomes.  CMS hopes to support providers through added access to important information about their patients so these goals can be realized.

6. WILL ADDITIONAL INFORMATION BE PUBLISHED BY CMS THAT SPECIFY FORMAT OR OTHER DETAILS ABOUT THE RULE?

There will not be any foreseeable modification to the CMS Interoperability and Patient Access Final Rule given it has already been finalized and published in the Federal Register. However, the CMS Center for Clinical Standards and Quality will publish interpretive guidelines for the e-notification CoP that will give additional information and instructions to the survey teams as they prepare to assess hospital compliance.

7. WOULD PROVIDERS SUCH AS SNFS THAT RECEIVE E-NOTIFICATION FROM HOSPITALS ALSO NEED TO BE RESPONSIBLE TO SEND E-NOTIFICATION TO HOME HEALTH AGENCIES AND HOSPICES?

This e-notification CoP only applies to hospitals, psychiatric hospitals, and Critical Access Hospitals and does not include e-notification provisions or requirements for other types of providers.  There are currently no CMS requirements in place that would require SNFs to send e-notifications to other post-acute providers or care settings.

8. ADT FEEDS CAN GO DOWN FROM TIME TO TIME. WHAT IS THE ALLOWABLE RECOVERY PROCESS AND TIME THAT AVOIDS PENALTIES?

Any downtime should be minimized but in cases where downtime does occur, it should be documented and resolved as quickly as possible.  For audit purposes, it will be beneficial to document information about downtimes so that any e-notification lapses can be justified and explained.  Hospitals or intermediaries should always address the root causes of any downtime to ensure that there are no systematic gaps in information sharing introduced and/or perpetuated.

9. DO HOSPITALS HAVE TO HAVE A SPECIFIC EHR FOR THIS COP?

Hospitals are not required to have a specific EHR under the e-notification CoP.  In fact, hospitals included as part of the e-notification CoP can have any EHR or other electronic administrative system that is conformant with the HL7 2.5.1 content exchange standard.

10. WHAT ABOUT NOTIFYING THE PATIENT’S INSURANCE CARRIER?

Under the minimum CoP requirements outlined in the final rule, hospitals have to send notifications only to the patient’s established primary care practitioner, practice group or entity; the practitioner, practice group or entity identified by the patient as primarily providing his or her care; and applicable post-acute providers and suppliers. Insurance carriers are not included in this minimum set of recipients. However, CMS states in the final rule that the CoP requirements only represent a minimum floor and do not prohibit the sharing of information with additional parties for treatment, care coordination, or quality improvement activities as long as required data sharing agreements are in place and all state and federal laws and regulations are followed.

What Can You Do To Be Ready?

To assess compliance readiness and required solution functionality, we strongly encourage hospital CIOs, compliance executives, and others responsible for ensuring CoP compliance to review the Key Considerations and the Compliance Checklist. These resources can help executive teams learn more about the CoP requirements and help them navigate their path to compliance.

For hospitals that will use third-party intermediaries to meet the e-notification compliance requirements, Bamboo Health’s Route solution offers a compliance guarantee and meets all the published requirements.  Visit our Route page to learn more.