Trump administration crackdown 'couldn't come at a worse time' for hospitals
[Note: This article has been updated to include comments from TeleTracking representatives and further response from the Montana Hospital Association.]
Earlier this month, the Centers for Medicare and Medicaid Services announced that hospitals that were not in compliance with reporting requirements from the U.S. Department of Health and Human Services could find their participation in the federal programs put at risk.
Starting October 7, CMS Administrator Seema Verma said that hospitals would have 14 weeks to come into compliance. She described "ample opportunity" to do so, with multiple enforcement letters and technological support available before termination.
Hospitals would also be required to report influenza data along with COVID-19 patient information, said HHS.
Around the country, hospital associations expressed their continued commitment to sharing data, along with concern that systems unable to do so may not receive reimbursement from Medicare and Medicaid.
"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.
"We would echo what was shared by the American Hospital Association – that hospitals are committed to providing timely and accurate information in a transparent manner," said Cara Welch, director of communications at the Colorado Hospital Association, to Healthcare IT News. "However, this should be done through partnership between hospitals and the federal and state agencies, not through mandates."
Welch said the CHA "is working closely with member hospitals and health systems who are working to be in compliance with this regulation.
"This has been a challenging process because of the accelerated timeline, the changing expectations and the manual data entry process that many of our hospitals have had to use."
A Mississippi Hospital Association spokesperson said, "MHA believes that it is important for all healthcare providers, not just hospitals, to report critical data which may be useful in responding to the COVID pandemic."
Though they said "the reporting requirements need to be focused and not overly burdensome," they said it was too soon to tell whether the current requirements could be classified as such.
In July, HHS triggered alarm among public health advocates when it directed hospitals to bypass the Centers for Disease Control and Prevention in reporting about COVID-19 patients. Health systems, some only given a few days' notice of the change, were thrown into "chaos," with some saying they faced technical difficulties and others pointing to the fact that closed hospitals were being listed as "non-reporting."
Some of these issues, say associations, are ongoing – making the threat of a crackdown even more fraught.
"We have noticed discrepancies between the data submitted by hospitals to the federal government and what is appearing in its data reporting platform," said Katy Peterson, vice president of communications and member engagement for the Montana Hospital Association.
"Specifically, hospitals have submitted data using methods and channels approved by HHS, and the submitted data is not posting to the appropriate fields within the [HHS Protect] system. This is not the fault of the hospitals," Peterson continued.
Peterson said these discrepancies have been acknowledged and confirmed by officials from TeleTracking (which collects data on behalf of HHS for its HHS Protect system), the Montana Department of Health and Human Services and Juvare, the health IT vendor that runs the approved platform used to report the data.
"Other state hospital associations are reporting similar issues," said Peterson.
Though TeleTracking is aware of issues related to Montana's data accuracy, said a spokesperson for the company after publication, "it is not related to us at all."
Though system bugs are to be expected, especially during rapid scale-ups, Peterson called it "patently unfair" to penalize hospitals as a result of them.
"Until there is a sound and reliable data reporting system in place, it is reckless to hold hostage the contracts between CMS and hospitals," she continued. "In Montana, this will penalize many hospitals that are properly submitting the required data. In a state where there may be only one hospital for 200 miles, it could also wipe out access to local healthcare when and where it is needed most."
Even without technical issues, said Peterson, some hospitals – particularly the state's smallest, frontier hospitals – still struggle to meet reporting requirements on a regular basis.
"The data requirements are particularly burdensome for facilities with extremely limited staff, but we are confident we can support them in meeting the government’s data reporting requirements in the time outlined under the new policy," said Peterson.
As the COVID-19 pandemic continues to ravage rural areas, some hospital associations expressed concern about the extra work incurred by the requirements. The financial fallout from the pandemic also makes the prospect of losing Medicare funding loom large.
"This is a lift, and couldn’t come at a worse time," said Dave Dillon, spokesperson for the Missouri Hospital Association. "Our rural hospitals are feeling the pinch as the virus is pushing throughout rural Missouri. Generally, rural hospitals have the fewest staff resources to dedicate to this. And, it is at a time where hospitals are experiencing significant surge and many also are experiencing workforce challenges."
Dillon said that building toward 100 percent participation is the goal, and that the association is making "great progress" where compliance is concerned in terms of working with those who aren't there yet.
"We realize that transparency is important. But using Medicare participation as a lever is beyond the pale," Dillon said. "Hopefully we’ll get to where CMS is satisfied, or 100 percent – whichever comes first."
Hospital associations resolved to continue working with existing tools to ensure they would be in compliance.
"OHA and Ohio hospitals are committed to supporting the state and national efforts of effectively managing the COVID-19 pandemic by making sure data is shared consistently," said John Palmer, director of media and public relations for the Ohio Hospital Association.
"Hospitals and health systems are working closely with the state and federal agencies to help facilitate the collection of this data while caring for our patients and communities on the front lines."
Upon receipt of the CMS memo outlining the reporting changes, said Palmer, OHA Data Services released a new app allowing member hospitals to comply through the OHA Hospital Resource Tracker.
"OHA is reviewing the changes in the latest HHS guidance and will provide an update to members regarding how the HHS data reporting changes will affect reporting to OHA. OHA is committed to adjusting our data submission application so that our members can meet HHS and/or CMS requirements and remain compliant," said Palmer.