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AAMC Comments on COVID-19 Medicare Hospital CoPs Rule

November 6, 2020

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CONTACTS
Mary Mullaney, Director, Hospital Payment Policies

The AAMC submitted comments on Nov. 2 in response to the Centers for Medicare & Medicaid Services’ (CMS’) interim final rule with comment (IFC) that requires mandatory hospital reporting of COVID-19 data in order to be compliant with Medicare Conditions of Participation (CoPs). Hospitals that do not report all data elements risk being terminated from the Medicare program. The AAMC opposes making COVID-19-related hospital reporting a requirement for Medicare CoPs.

The AAMC is concerned with how the CMS is evaluating reporting. On a stakeholder call on Oct. 29, CMS officials acknowledged that the new reporting requirements are viewed as “all or nothing.” If a hospital fails to submit data for all fields, then the CMS considers the hospital to be noncompliant for each day that reporting is not viewed to be 100% completed. In other words, even if a hospital is reporting 99% of the required data, it would be considered noncompliant based on the 1% of missing data. The AAMC believes this is extreme and unnecessarily punitive given the vast amount of data hospitals are required to report each day.

The AAMC agrees with the need for transparency in COVID-19 data reporting. “Despite multiple inquiries on the purpose and use of this data collection, the administration has yet to communicate how it is using the data to guide the federal government’s response to the pandemic,” the letter states. The AAMC calls upon the Trump administration to be more transparent on the reasons for collecting this massive amount of information, how the data is currently being used, and the future plans for the data’s use.

The new reporting requirements also include new reporting on influenza. While these questions are currently voluntary, related HHS guidance makes clear the intention to make them mandatory. However, it is unclear what the purpose for inclusion of these questions is and whether they are the best ones to ask hospitals to report. Stakeholder input in developing data metrics to ensure meaningful data capture and evaluate the need for inclusion in hospital reporting requirements is vital. The CMS has historically allowed for stakeholder input in subregulatory guidance. In its letter, the AAMC urges the CMS to not finalize the influenza questions but instead seek stakeholder input in an open and transparent format to ensure accurate and valuable data is captured and to decrease hospital burden.

Finally, the IFC also ties in-house lab reporting to Medicare CoPs compliance. The IFC acknowledges that this requirement would require some hospitals to double report data to their state and the CDC. The AAMC is concerned that this requirement may result in possibly double-counted or inconsistent data in the system. Even though some hospitals submit the data to their state and their state in turn submits it to the CDC, all hospitals that perform in-house COVID-19 testing must report aggregate data to the HHS through the HHS Protect platform until they have confirmed that the CDC is receiving their information through their state. 

The AAMC is concerned that tying lab data reporting to hospital CoPs further jeopardizes hospital compliance. This is on top of the CMS’ Oct. 15 announcement that it will reduce reimbursement for COVID-19 testing if results are not available within two days. The potential for hospitals to be out of compliance, coupled with the reduced reimbursement, could disincentivize hospitals from processing COVID-19 laboraory tests in-house.

Given the urgent need to increase COVID-19 testing across the country at this time of rapidly increasing infection rates, the AAMC wants to ensure that no laboratory is disincentivized to do COVID-19 testing for fear of jeopardizing the hospital’s participation in federal health care programs. Thus, the AAMC urges the CMS not to include in-house lab data reporting as a CoPs requirement for a hospital.

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