HHS will require hospitals to report flu information, in addition to COVID-19
[This piece has been updated to include a comment from the American Hospital Association and more information about the CMS final rule.]
The U.S. Department of Health and Human Services announced Tuesday afternoon that it would begin requiring hospitals to include data elements about influenza patients to their daily COVID-19 reporting.
Starting Wednesday, hospitals will have 14 weeks to come into compliance with the requirements, said Centers for Medicare and Medicaid Services Administrator Seema Verma on a call with reporters.
"Noncompliance could result in termination for both Medicare and Medicaid, meaning the hospital would not receive reimbursement from these programs," said Verma, who said that termination is the only sanction the agency has available for hospitals.
Officials did not specify on the call which new elements were going to be added, how many hospitals were currently in 100% compliance or what exactly hospitals would be required to report. Some of that information was later clarified in an interim final rule published on the CMS website, which stated influenza data should be optionally reported starting October 19 and that doing so would be "mandatory in the coming weeks."
"Tying data reporting to participation in the Medicare program remains an overly heavy-handed approach that could jeopardize access to hospital care for all Americans," said American Hospital Association President and CEO Rick Pollack in a statement.
Although the guidance does answer some outstanding questions about compliance, Pollack said, "We have observed errors in data processing and confusion about exactly what was being requested at the hospital, state, contractor and federal level and have worked diligently with the federal agencies to identify and correct those problems."
Reporting success, he continued, "was made possible by partnership, not mandates."
WHY IT MATTERS
Since directing hospitals to bypass the Centers for Disease Control and Prevention and report directly to HHS this summer, the agency has maintained that regular data entry is necessary to give the government the fullest possible picture of the pandemic. Hospitals can report via HHS' TeleTracking portal, through their state health departments or via their health IT vendors.
Until the end of September, the agency said it used the COVID-19 data to determine allocation of the treatment drug remdesivir. Since then, hospitals have been able to directly purchase the medication from the distributor.
Now, the government says it wants the data to ensure that new therapeutics will be available to hospitals as they're developed and to give them visibility into the needs of hospitals.
"That dialogue with the hospitals has continued to evolve" regarding data reporting needs, said Dr. Deborah Birx, White House task force coordinator. For example, hospitals no longer have to report their personal protective equipment supplies daily; rather, they can do so weekly. They can also enter information on Monday and backdate it to the weekend if necessary.
The addition of influenza data elements, said Birx "will allow us on a daily basis … to evaluate and query what the non-COVID, non-influenza respiratory diseases are."
"We think it's very important for governors to know where there are gaps in the database to understand where there are trends and trend lines," Birx continued.
The six new influenza reporting requirements "won't replace the current surveillance system," said CDC Director Dr. Robert Redfield. Rather, the new data "will give us an improved situational awareness" and "provide local hospitalization trends," he said, while also giving insight into necessary resources.
These requirements will include the number of ICU patients with flu, which patients in hospitals have both influenza and COVID-19, and the number of deaths from influenza.
"CDC is preparing for there to be a COVID-19 and seasonal influenza activity at the same time," said Redfield.
Regarding the 14-week enforcement timeline, Verma said that hospitals will have "ample opportunity" to come into compliance, describing multiple enforcement letters and technological support before termination. Hospitals will also have the right to appeal termination.
When asked by Healthcare IT News about reports of closed hospitals showing up as nonreporting (and therefore noncompliant), Verma reiterated that the 14 weeks would be enough time to work out the kinks.
"If there is a problem, if there is an administrative issue, we have the opportunity to work with those hospitals one-on-one to make sure" things run smoothly, she said.
HHS did not offer statistics about how many hospitals were currently in full compliance, but senior officials said they would start publishing information about which hospitals weren't compliant on October 21.
The work to get hospitals into compliance has been an ongoing effort, said Verma.
"What's new is we're starting to enforce it using the conditions of enforcement," she said.
THE LARGER TREND
Hospital associations raised the alarm about the revocation of Medicare funding in late September, when news of the change leaked.
Given the precarious financial situation many hospitals find themselves in, some called the threat "the nuclear option."
"Removing CMS certification for Medicare would create financial peril for any hospital. Worse, it could in many communities eliminate access to care," said Dave Dillon, spokesperson for the Missouri Hospital Association, to Healthcare IT News.
"The goalposts keep moving as we advance through the crisis," said Dillon.
Before the latest change, many hospitals said they'd adjusted to the new reporting requirements. Some said their state health departments had taken on the job. Meanwhile, HHS extended its contract with TeleTracking another six months.
"Over the course of our contract with Health and Human Services, we have proven that we can systematically improve compliance and enable hospitals around the country to report on their COVID-19 data quickly, consistently and transparently," TeleTracking president Christopher Johnson told Healthcare IT News.
ON THE RECORD
"At the end of the day, this is about patients," said Verma. "All of this reporting ensures that frontline patients and workers have the supplies they need."