Clarifying 5 Misconceptions about CMS’s E-Notifications Condition of Participation

Clarifying 5 Misconceptions about CMS’s E-Notifications Condition of Participation

The Centers for Medicare and Medicaid Services (CMS) recently finalized the new e-notifications Condition of Participation (CoP) to accelerate existing information sharing practices and improve collaboration and coordination across the care continuum. Specifically, the CoP will require hospitals to send electronic patient event notifications, or e-notifications, to other community-based providers and groups, including post-acutes, that need e-notifications to improve the care for their patients. Compliance with the new CoP will be critical for hospitals as deficiencies can jeopardize a hospital’s provider agreement with CMS and its certification status. The new CoP goes into effect on May 1, 2021 giving hospitals just a few months to implement a solution.

PatientPing fielded a survey in June 2020 asking hospital CIOs and compliance executives about their perceptions of the new e-notifications CoP. Of the over 70 executives that responded to the survey, only 17% indicated that they were familiar with the new requirements yet over 90% of those respondents felt they would be able to meet compliance requirements by May 2021. Notably, the survey exposed several misconceptions about the new requirements and highlighted some inaccurate assumptions. To help CIOs and compliance leaders understand the full CoP requirements and the capabilities needed to meet them, we’ll address the main misconceptions below and offer additional information to increase awareness and readiness.

5 Misconceptions about the new CoP

My EHR vendor will ensure 100% compliance with the e-notifications CoP

Seventy-five percent of survey respondents agreed or somewhat agreed that their EHR will ensure their full compliance with the new CoP. EHR vendors typically provide solutions to enable Direct Messages upon inpatient events, in particular discharge events, as was specified under Meaningful Use. Under the new CoP, however, the notification requirements are expanded where hospitals must send notifications upon all inpatient and emergency department events. Furthermore, those notifications must not only be sent to providers identified in the EHR but also to those providers with attributed patients that request notifications to support treatment and care coordination activities. To do so, solutions need three key components: 1) manage notification requests from patients’ attributed providers across the care continuum, 2) accurately match patients’ care events, and 3) send notifications based on the matches in real time to the appropriate practitioner or entity. Any hospital that aims to rely on their EHR vendor to meet compliance requirements should assess whether the vendor can ideed offer a complete solution and how it might guarantee compliance.

My local Health Information Exchange (HIE) will ensure 100% compliance with the e-notification CoP

Seventy-five percent of respondents also agreed or somewhat agreed that their local HIE will help hospitals achieve full compliance with the new CoP requirements. Importantly, the CoP requires e-notifications be sent at the time a patient event occurs to any established practitioner, practice group/entity, or post-acute regardless of their geographic location. Hospitals should consider that most HIEs send notifications only within their state or regional borders and may not have the required dynamic roster or census capabilities developed to service in the full range of providers as required by the CoP. Such limitations would prevent notifications to be sent in real time on behalf of the hospital to all providers that must receive them. Since hospitals will be ultimately held accountable for meeting compliance requirements even if they use an intermediary, hospital leaders should evaluate their HIE’s capabilities and assess if they might face non-compliance risk and undue exposure.

My organization has the capabilities today to field all external requests for e-notifications from community providers

The CoP requires that hospitals send e-notifications to all providers that need the information for treatment, care coordination, or quality improvement activities. This includes providers with attributed patients that are not necessarily identified by patients at the point of care. Just under 50% of respondents stated that they have the capabilities in place to address all external requests from other community-based providers for their attributed patients. Meeting these requests will require hospitals or their intermediary to manage patient rosters and match patient care events to those rosters which then trigger notifications. Because care relationships can change daily, especially in the post-acute setting, patient attribution information from rosters needs to be updated accordingly which can increase the technical complexity of managing e-notifications. In addition, any necessary data share agreements need to be in place between the hospital and the notification recipient to ensure compliance with all federal and state laws and regulations. Hospitals should consider the workflows and processes they have in place to meet these requirements and whether they can adequately address them.

My organization doesn’t need to prioritize this requirement yet given the compliance deadline is several months out

Only 42% of respondents stated that meeting the new CoP is of high priority to their organization currently. Given the significant consequences of non-compliance, hospitals should assess their existing notification capabilities and identify any gaps as quickly as possible as building a solution or vetting a third party intermediary will require time. As the May 1, 2021 compliance deadline approaches, hospitals should use this time to determine their compliance needs and solution. Given the possibility of a second COVID-19 wave and other pressing IT-related priorities, hospitals should ensure they adequately plan for the compliance solution implementation with enough lead time to meet the deadline.

My organization is well positioned to meet all compliance requirements

A vast majority of survey respondents, over 90%, that were familiar with the CoP were also confident that their hospital or health system will meet compliance requirements by the May 2021 deadline.  While this level of confidence is encouraging, each hospital or health system should fully assess their current capabilities and compare those against the CoP requirements. The CoP intends for hospitals to adopt a more comprehensive information sharing solution so hospitals must understand and address all requirements to avoid deficiencies on surveys. Any gaps in notification sending and routing should be identified and hospital leaders should determine whether to address these gaps by building their own solution or by using an intermediary to supplement existing systems.

Given the significance of the new e-notifications CoP, CIOs and compliance leaders should take time to carefully assess and validate internal or third-party capabilities against the new requirements to ensure they can meet compliance by May 2021. We have made a comprehensive list of compliance requirements available for review. A close assessment of the key CoP compliance considerations can also help leaders determine their options and make a more informed decision about the best solution for their organization. CIOs and compliance executives can learn more about the e-notifications CoP by visiting or by contacting [email protected].