Countdown to Compliance: Answers to the Most Frequently Asked Questions About E-Notification Requirements Under CMS’s New Interoperability and Patient Access Rule

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By Jay Desai

In March, 2020, the Centers for Medicare and Medicaid Services finalized their Interoperability and Patient Access Rule, which creates a new Condition of Participation that requires hospitals, psychiatric hospitals, and Critical Access Hospitals to share electronic event notifications (e-notifications) with other providers across the care continuum whenever patients have inpatient or emergency department care events. The goal of the CoP is to increase information sharing across the care continuum to enable better care coordination leading to improved patient outcomes.  This compliance requirement will go into effect on May 1, 2021 and adds to the list of CoPs hospitals must fulfill to maintain their CMS provider agreement and certification. 

A recent PatientPing survey to gauge hospital CIOs’ awareness of the e-notifications CoP found that just 17% of respondents are familiar with the CMS requirements. With the e-notifications CoP deadline 10 months away, two-thirds of those surveyed are less than confident that their organization will be compliant to meet the deadline, even while 90% of respondents agreed that it is a priority for their organization to ensure compliance with the e-notifications CoP.

To help hospitals prepare for the e-notifications CoP, below are answers to commonly asked questions from hospital CIOs and compliance chiefs that PatientPing collected through industry conversations, virtual focus groups, and webinars.

Which providers need to receive e-notifications?

Hospitals must send e-notifications to community-based providers that have established patient care relationships and that need the information for treatment, care coordination, or quality improvement activities.  CMS specifies four required categories of notification recipients:

  1. Established primary care practitioners
  2. Established primary care practice groups or entities such as an FQHCs, primary care group practices, Accountable Care Organizations, etc. 
  3. Other practitioners, or practice groups/entities identified by patient as the practitioners, or practice groups/entities primarily responsible for their care
  4. Post-acute providers such as a Skilled Nursing Facilities, Home Health Agencies, etc.

How will hospitals know which providers have established care relationships?

To determine providers with established care relationships that need to receive e-notifications based on CMS requirements, hospitals or their intermediary need two distinct capabilities:

  1. Ability to collect patient-identified provider information at the point of care
  2. Ability to obtain care relationship information from providers through a patient roster and notification request process

The first capability allows hospitals to determine any providers with whom the patient wants their information shared by giving patients the ability to identify their providers at the point of care. The second capability allows hospitals or intermediaries to determine any additional practitioners, practice groups/entities, or post-acutes that need to receive notifications for treatment, care coordination, or quality improvement activities. The roster and notification request process allows 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 both of 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. Also, the number of e-notification recipients will vary by the number of providers a patient has and does not prescribe a limit on the number of providers that can receive e-notifications. 

Even with the CoP in place, hospitals still have an obligation to send e-notifications consistent with patients’ privacy preferences and in accordance with applicable state and federal laws and regulations. Under the CoP, hospitals are not required to send e-notifications to recipients that have opted out of receiving notifications, that cannot be identified after following implemented e-notification processes, and/or that don’t have the capability to receive e-notifications. 

How is “real-time” for sending notifications defined in the CMS final rule?  Is there a specific timeframe (e.g. 24 hours), that CMS specifies?  

Hospitals are required to send e-notifications at the time of a patient’s inpatient admission, discharge, and transfer (ADT) and at ED presentation/registration and discharge. CMS was deliberate in requiring e-notifications be sent in real time, i.e. “at the time of” a patient event occurring not only to eliminate information delays and improve current information sharing practices, but  to guarantee the information is actionable to maximize care coordination opportunities across the care continuum to improve patient outcomes.  Delays lasting hours or days, or sending batched e-notifications, will not meet this rule requirement.

Will hospitals that already send their ADT feed to Health Information Exchanges (HIEs) be automatically compliant with the CoP?

Compliance will depend on whether the HIE, as the hospital’s intermediary, can fulfill the minimum requirements specified within the final rule, including the ability to send e-notifications:

  • For all required patient events – inpatient ADT events as well as for ED presentation/registration 
  • In real time – at the time of ADT and presentation/registration
  • Including, at minimum, patient name, treating practitioner name, and sending institution name
  • To the practitioners, practice groups or entities, and post-acute providers and suppliers identified directly by patients 
  • To the established primary care practitioners, established primary care practice groups or entities, and applicable post-acute providers and suppliers that have an active care relationship with the patient and request information for treatment care coordination, or quality improvement activities
  • Consistent with patients’ privacy preferences – no e-notifications should be sent for patients who opt out 
  • To recipients who have required data-sharing agreements in place and consistent with all applicable federal and state laws and regulations  

Furthermore, to minimize potential security incidents and inaccurate notifications, a high accuracy match rate should be in place to ensure notifications are sent to the appropriate providers as well as capabilities to frequently update provider-patient care relationships.  Ultimately, hospitals are accountable to meet compliance requirements even when they delegate the e-notification functions to HIEs or other intermediaries and should ensure that all minimum requirements are met.

Stay tuned for part two of this article series. 

Jay Desai is CEO & Co-Founder of PatientPing.

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