How Would Proposed CoP Requirements Impact Hospitals?

CMS is proposing the same e-notification Conditions of Participation (CoPs) requirements for eligible hospitals, psychiatric hospitals, and Critical Access Hospitals (CAHs). We review these general requirements and discuss their anticipated impacts below.  

Review of the Proposed E-notification CoP Requirements

CMS’s proposed e-notification CoPs would require Medicare- and Medicaid-participating hospitals, psychiatric hospitals, and CAHs to send e-notifications to eligible practitioners, care teams, and PACs when their shared patients have an inpatient event. CMS would limit the CoP requirements to only those hospitals that already have operational EHR systems with the capacity to generate admission, discharge, and transfer (ADT) messages that can be shared as e-notifications with the eligible requesters.

Hospitals would be required to send e-notifications, using the HL7 2.5.1 standard, to requesters at the point of a patient’s inpatient admission, discharge, or transfer. E-notifications would need to include, at minimum, patient name, treating practitioner name, sending institution name, and, if not prohibited by other applicable law, patient diagnosis. Hospitals would have the option to meet CoP compliance requirements either by managing e-notifications directly or by using an intermediary.

All practitioners, care teams, or PACs that request e-notifications from hospitals must have an established care relationship with the patient, be able to receive e-notifications, and use the information for treatment, care coordination, or quality improvement purposes.

Understanding the Impact

To meet the proposed e-notification CoP requirements, hospitals, psychiatric hospitals, and CAHs will need to engage with their IT/interoperability and compliance teams to determine effective ways to ensure e-notification compliance. Based on the proposed rule, compliance will be met if hospitals are able to fulfill e-notification requests from all eligible requesters and if hospitals have a reasonable certainty that e-notifications will be received by the requester. In effect, hospitals will need to determine how to best manage incoming requests and how to ascertain if requesters are eligible and able to receive the e-notifications.

E-notification requests will come from a cross-section of practitioners, including community-based primary care providers and specialists, as well as from value-based care program participants, care coordination teams, and PAC providers, including Skilled Nursing Facilities and Home Health Agencies among others. The demand for e-notifications will depend, in part, on hospital size, patient volume, and on the types, number, and geographic distribution of referral partners.

Impacted hospitals need to either develop their own technical solution to meet e-notification requests or work with an intermediary to manage the requests on their behalf. To ensure appropriate e-notification sharing, CMS expects hospitals to develop processes to ascertain care relationships directly or to rely on the intermediary to facilitate that process.

To minimize burden, hospitals should consider the anticipated resource and staffing needs, technical requirements, potential security risks, administrative needs, and other costs or fees when evaluating options to meet the proposed e-notification CoPs.