The CMS E-Notifications CoP Compliance Breakdown: Small-Sized Hospitals

The Centers for Medicare and Medicaid Services’ (CMS) Interoperability and Patient Access E-Notifications Condition of Participation (CoP) deadline is rapidly approaching for hospitals and health systems. From the smallest rural hospitals to the largest health systems, compliance with this CoP brings varying levels of complexity. Apart from the CoP, small-sized hospitals face several unique challenges daily – whether it be limited physicians or more limited access to financing than larger institutions. Variables like these, combined with a global pandemic and looming deadline for achieving compliance with the new CMS CoP, make for a challenging scenario.

For CIOs and IT professionals working in a small-sized hospital, who often lack the compliance and technical support of larger hospital systems, the time to prepare is now. It is critical for small-sized hospitals to understand the intricacies of the new rule and adjust their practices accordingly to ensure 100% compliance with the e-notifications CoP. Below is a list of common Q&A’s to consider when assessing what, if any, changes your hospital needs to make. These questions can be used as a resource to help clarify any misconceptions and provide advice for implementing a CoP solution that addresses the unique pain points that small hospitals deal with every day.

Does my hospital’s existing relationship with our EHR vendor ensure 100% compliance with the e-notifications CoP?

While most EHR vendors typically provide solutions to enable Direct Messages upon inpatient events, in particular discharge events, as was specified under Meaningful Use, the new CoP notification requirements are expanded where hospitals must send notifications upon all inpa – tient and emergency department events. Furthermore, those notifi – cations must not only be sent to providers identified in the EHR but also to those providers with attributed patients that request notifica – tions 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) ac – curately 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 its EHR vendor to meet compliance requirements should assess whether the vendor can indeed offer a complete solution and how it might guarantee compliance.

Most of our patients are local. Is our HIE able to ensure 100% compliance with the e-notification CoP?

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. While most care events in your smaller system may be local, the CoP requires that your hospital account for all scenarios to ensure care coordination both within your system and beyond so you must account for scenarios such as a patient traveling across state lines. Since most HIEs send notifications only within their state or regional borders, they 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. As a small hospital system, we’re looking to save costs as much as possible.

What kind of increase can our hospital expect to see in our operating budgets by setting up this process?

Can we handle the requirements internally? 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. Hospitals planning to set up a process to handle the requirements internally will need to plan for a moderate to a significant increase in their operating budgets, as it will require a full assessment of their current capabilities compared against the CoP requirements. Meeting these requests will require hospitals 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 will also need 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, processes and human resource requirements for establishing this type of infrastructure to determine if they can adequately address them. In most cases, an alternative solution can be more cost-effective and provide more insight than implementing a manual approach.

We can afford to take on more risk than a larger hospital system, so why do we need to prioritize this requirement now?

Every hospital from small to large is governed by this rule, so the 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. Given the significant consequences of non-compliance, hospitals of all sizes need to 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 need to consider the workflows and processes they have in place to meet these requirements and whether they can adequately address them.