The CMS E-Notifications CoP Compliance Breakdown: Large Hospitals and Health Systems

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. Large hospitals and health systems face a complex web of challenges – from facilitating workflow consistency to ensuring the quality of patient care and beyond. Variables like these, along with the looming deadline for achieving compliance with the CMS Interoperability and Patient Access Rule E-Notifications Condition of Participation Provision, as well as the pandemic, make for a complex situation, especially for CIOs and administrative professionals who often have more robust IT systems requiring added compliance and technical complexity than smaller hospitals.

Given the significance of the new e-notifications CoP, CIOs and compliance leaders should take time to carefully assess the new requirements to ensure they can meet compliance by May 1st. We’ve compiled a checklist of Q&A’s to help guide you through the process. 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 large hospitals and health systems deal with every day.

Does our existing relationship with our EHR vendors ensure 100% compliance with the e-notifications CoP?

EHRs have a critical role to play in enabling interoperability to support policy goals. However, like all software, EHRs are limited by their functional capabilities, adoption within and outside the provider community, and delivery/support model. Unlike the CMS Meaningful Use Program, there are no accompanying set of certification requirements or responsibilities imposed on the EHR (or for that matter, an HIE) in order to meet the e-notifications CoP requirements in the CMS Interoperability and Patient Access Rule. The responsibility is entirely on the shoulders of the health system. As such, it is important that health systems sufficiently evaluate the CoP support being developed by their EHRs to ensure that they successfully comply with this important rule.

Our organization is well-positioned to meet the majority of the compliance requirements. Do we really need to field all external requests for e-notifications from community providers?

For health systems with large provider and post-acute referral networks, hospitals must send e-notifications to community-based providers that have established care relationships with patients, including: primary care practitioners, FQHCs, other entities identified by the patient as primarily responsible for their care, and post-acute providers (skilled nursing facilities, home health agencies, etc.). This information is needed for treatment, care coordination, or quality improvement activities. Therefore, identifying which providers have established care relationships is critical and requires that hospitals, or their intermediary, possess the capabilities to collect patient-identified provider information at the point of care; and obtain care relationship information from providers through a patient roster and notification request process. The roster and notification request process allow providers to identify their care relationships through a roster, such as a patient panel or census list, and receive e-notifications based on hospital care events that match to patients on those rosters. Having these capabilities gives hospitals the ability to determine the required set of providers that need notifications, thereby eliminating e-notification gaps that would lead to non-compliance.

We have a large network of providers and access to a significant amount of electronic data. Is this combined with our HIE network enough to ensure 100% compliance with the e-notification CoP?

HIEs can help with e-notifications compliance, but the hospital is ultimately responsible for ensuring the intermediary it uses is a fully compliant solution. Depending on the HIE’s capabilities, post-acute network coverage, and the hospital’s own geographic reach, there might be gaps that need to be filled. 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 the full range of providers as required by the CoP. These types of limitations would prevent notifications from being sent in real time on behalf of the hospital to all providers that must receive them. With the ultimate burden of accountability falling on hospitals to meet compliance requirements even if they use an intermediary, it is important for hospitals to proactively assess the capabilities of their HIE in order to avoid non-compliance risk and undue exposure.

We don’t want another layer of technology to log into to send and receive data. Can we handle the requirements internally?

The new CoP promotes the adoption of a more comprehensive information sharing solution, which makes it an important step for improving care coordination efforts nationwide. In order to avoid deficiencies on surveys, hospitals must understand and address all requirements. Any gaps in notification sending and routing will need to be identified and hospital leaders must determine whether to address these gaps by building their own solution or by using an intermediary to supplement existing systems. Large hospitals and health systems setting up their own process for handling the requirements internally should plan for a moderate to significant increase in their operating budgets, as it will require a full assessment of current capabilities compared against the CoP requirements. To meet these requests, hospitals are required to manage patient rosters and match patient care events to those rosters, which then trigger notifications. This means that because care relationships can change daily, patient attribution information from rosters will also need to be updated accordingly, which can increase the technical complexity of managing e-notifications. Beyond this, hospitals will need to establish necessary data share agreements between the hospital and the notification recipient to ensure compliance with all federal and state laws and regulations. For large hospitals and health systems, it is also important to consider any updates to workflows, processes, and human resource requirements for establishing this type of infrastructure in order to determine if they can adequately be met. Many hospitals are finding that alternative solutions are often more cost effective and more easily integrated with existing technology – delivering more insight than a manual approach can provide.