Hospitals and nursing homes are wary of CMS' new COVID-19 testing and reporting requirements and the fines associated with them, calling the plan "heavy handed" and "unrealistic."
CMS' Tuesday guidelines included a hefty $400 per day fine for noncompliance with the requirements, which could top more than $8,000 a case. The agency could also deny providers Medicare and Medicaid payments for new admissions. The added penalties is another move meant to protect nursing home residents and patients, CMS said.
But providers are still facing limited supplies and staff, and claim the approach won't make it easier for them to care for patients.
Ali Santore, senior vice president of government affairs for Renton, Wash.-based Providence Health System said the health system has had to create a "task force on top of a task force" to track the changing regulatory requirements for hospitals. While one team collects and reports data, another is focused on tracking changes to requirements.
"This rule created increased regulatory burden on providers in the middle of a pandemic with no end in sight," Santore said. "Our time is taken away from the actual data collection because we're trying to determine what we're supposed to be collecting and what portal its supposed to be going into. We have data collection whiplash from all of the requests that have been sent our way."
Since the pandemic hit Washington earlier this year, Providence has cared for 4,000 patients with COVID-19 and performs testing in house, she said.
"We find this rule to be overly onerous and the penalties to be extreme," Santore said. It certainly takes time away from our day jobs and from our care of patients."
Under the interim rule, nursing homes need to routinely test staff and residents whenever there is an outbreak. The frequency is determined by the rate of community spread in the area.
Katie Smith Sloan, president and CEO, LeadingAge, the association of not-for-profit providers of aging services, said the penalties on nursing homes are "adding insult to injury" and that facilities are already struggling to afford the added costs of personal protective equipment, staffing, cleaning supplies, staffing bonuses, testing supplies and lab tests.
"The reality is that most every home has been making a herculean effort to protect lives without funding or clarity of policy, she said. "This week's funding and tools help to offset the costs they're incurring, but without fully funded resources, we are fighting with one hand behind our backs."
The financial penalties are meant to punish facilities that aren't making a good faith effort to comply but Dr. Noah Marco, chief medical officer of the Los Angeles Jewish Home, said they likely will force good nursing homes to close, too.
CMS hopes nursing homes will benefit by 15,000 rapid point-of-care testing devices that it will send to the facilities, as well as $5 billion from the Provider Relief Fund. CMS also on Tuesday launched a staff training program on infection control and prevention for CMS-certified nursing homes.
However, Marco said the point-of-care machines can't be used for surveillance testing at his organization's facilities because county and state regulations require PCR testing.
Those conflicting local and federal policies have put providers in a difficult position, Smith Sloan said.
"Navigating this maze of policies is not only confusing and therefore time consuming, it can also mean duplicated efforts — having to use multiple tests, for instance, or report to multiple organizations," she said.
Hospitals will face slightly different requirements. They have to report COVID-19 related data daily on the number of confirmed or suspected positive patients, ICU beds occupied and availability of supplies and equipment like ventilators and PPE, CMS said.
The agency will warn hospitals that miss a day and give them a few weeks to come into compliance before Medicaid and Medicare payments are withheld, CMS Administrator Seema Verma said. After that point, the hospitals could be terminated from the Medicare and Medicaid program.
Labs and nursing homes or other labs that complete COVID-19 testing must report their results daily. If they don't, they face a $1,000 for the first day and $500 each subsequent day once the rule goes into affect.
Approximately 94% of hospitals were already submitting accurate COVID-19 data to the federal government before Tuesday's announcement, according to American Hospital Association President and CEO Rick Pollack. He said he was suprised by the new requirements and penalties.
"This is a heavy-handed approach that could jeopardize care in the midst of a pandemic," he said. "Most hospitals can't survive without Medicare and Medicaid."
U.S. hospitals receive an average 52.3% of their patient revenue from Medicare and Medicaid, according to the AHA.
"In theory, I think this rule makes a lot of sense," said Lissy Hu, CEO and founder of CarePort Health, a care coordination company that connects hospitals and nursing homes. "In practice, I'm not sure how realistic this is going to be."