The COVID-19 pandemic has highlighted the importance of our health care data system and the shortcomings that must be addressed. But a new rule recently promulgated by the Centers for Medicare and Medicaid Services – ostensibly to improve data reporting – could undermine the very hospitals and others we are counting on to get America through this public health emergency.
We were flying blind when the pandemic began. Accurate data on needed details concerning the virus, such as locations and numbers of new cases, deaths, resources and treatments, was essentially not obtainable in real time. Personal protective equipment and other important supplies could not be located, while their procurement costs soared and the quality became increasingly questionable. Officials attempting to address the myriad of issues surrounding efforts to combat the pandemic soon learned that we have a fractured public health care system that lacks a centralized, robust, streamlined, transparent real time data analytics system.
As a result, on July 15 the Department of Health and Human Services published a memo advising that HHS would be updating the data reporting process. Providers, including hospitals, would now be required to report information to HHS TeleTracking, instead of the Centers for Disease Control National Health Safety Network they had been using for decades. The number of data points to be reported was expanded to include information about patients, the number of beds and ventilators that are available, and staffing shortages. HHS stated that the change will inform the COVID-19 Task Force and others about capacity, resources and supplies to ensure a more coordinated effort to address the pandemic.
The memo was followed on Aug. 25 by an interim final rule issued by CMS as an emergency regulation under the public health emergency , making it effective immediately upon publication. Many legitimate concerns and unintended consequences associated with this IFR have since become apparent.
Hospitals have expressed concern that the IFR was promulgated without adequate notice or input from the industry and at a time when facilities are struggling to keep pace with the demands of caring for patients. Importantly, the rule did not address whether hospitals will be relieved of their other reporting responsibilities to the CDC, local and state health departments and other government agencies that are duplicative or no longer necessary. Tragically, the regulation continues to support a broken system instead of addressing the identified systemic shortcomings and problems of the existing federal data system and directing resources to build a new unified system. In the meantime, hospitals and providers have been forced to dedicate additional staff time to continue to layer onto duplicative reporting systems.
Already overworked front-line responders will now have to immediately learn new collection and reporting standards and begin reporting to an additional agency to comply with the IFR. An expense of additional staff would also be problematic since hospitals are facing financial shortfalls caused by a ban on elective surgeries that was just recently lifted. Such outpatient procedures generally provide revenue to offset losses hospitals experience in providing lower reimbursed inpatient care.
The rule also requires hospitals to provide daily updates via HHS TeleTracking as a condition of participation in the Medicare and Medicaid programs. Therefore, if a facility does not meet the requirements, CMS will terminate facility participation in the program and reimbursement for services will end.
Medicare accounts for around 40 percent of a hospital’s reimbursements and removing a facility from the program would likely force them to close their doors. Smaller rural hospitals which hardly have the staff to comply with such requirements and are at particular risk, since Medicare patients usually make up an even larger percentage of their revenues. At least 170 rural hospitals in 36 states have shut their doors since 2005 and the numbers will likely continue to escalate if additional requirements are placed on these at-risk facilities. The sum total of all of this means that there will be less access to care in the midst of a pandemic.
The Trump administration’s willingness to examine and address a broken data system to avoid another shut down should be supported, but there must be a better way to go about accomplishing this goal. Implementing such a sweeping and punitive approach to data collection is difficult while facilities and providers are currently experiencing tremendous workforce and financial strains.
We must modernize the existing data reporting system to meet the current and upcoming health care challenges. An accurate, aligned, streamlined, nonduplicative and accessible data collection and analytics system is necessary. However, a more collaborative, incremental and less punitive approach should be implemented.
Vickie Yates Brown Glisson is the former Kentucky Secretary of the Cabinet for Health and Family Services and a nationally recognized health lawyer.
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