The CMS ADT Mandate Is Coming. Are You Ready?

October 15, 2020

Todd Thompson, BSN, RN – Clinical Subject Matter Expert

The CMS ADT Mandate Is Coming. Are You Ready?

Are you ready to share admissions, discharge and transfer (ADT) data with other providers in 2021? Sharing this information can help improve care coordination and lower readmissions, while failing to do so can put you in violation of a new CMS mandate.

The new regulation gives hospitals an incentive to notify primary care physicians (PCPs) and post-acute care facilities when patients are admitted to or discharged from the hospital, or transferred to another facility. The goal is to boost quality, efficiency, and continuity of care to help improve patient outcomes.

But there’s still uncertainty about the best way to share this information accurately, efficiently, and securely. Let’s explore some of the ways you can address these barriers, but first, a quick recap on the details of the mandate.

CMS ADT E-Notification Regulation Overview

The new CMS mandate will require ADT notification to the patient’s preferred PCP, physician group, or post-acute care service as of May 1, 2021. Under the regulation, hospitals must make a reasonable effort to send notifications to “…all applicable post-acute care services providers and suppliers as well as to any of the following practitioners and entities:

1. the patient’s established primary care practitioner (PCP);

2. the patient’s established primary care practice group or entity; or

3. other practitioner, or other practice group or entity, identified by the patient as the practitioner, or practice group or entity, primarily responsible for his or her care.”

The rule applies to hospitals with EHRs, including psychiatric and critical access hospitals. In short, the hospital must share ADT information with PCPs, physician groups, skilled nursing facilities (SNFs), home health, hospice agencies, and other providers in their care community.

Notifications include ED registration, ED admission to inpatient status, discharge, or transfer from inpatient or ED services. CMS is not expected to require notifications for transfers within the hospital, such as step down from ICU to another status. Notifications must include at least the patient name, treating practitioner name, and the sending institution. Diagnosis details can be included if permitted by state and federal law but are not required.

Technology Options and Best Practices

So how can your organization comply with the 2021 Condition of Participation (CoP) mandate? Start by choosing a technology solution that not only sends e-notifications efficiently but also improves care collaboration. Here are some things to consider:

Choose a solution that integrates with your EHR. The interoperability challenges between EHRs and the wide range of clinical systems used by hospitals, physician practices, SNFs, and other care settings create a significant barrier in meeting this mandate. You will likely need a third-party solution beyond an EHR application to ensure successful sharing of ADT information.

Understand the limitations of your HIE. Health information exchanges (HIEs) can send ADT messages to PCPs and post-acute facilities if they are part of that network. This method has limitations, however, because it’s unlikely that every PCP, home health agency, nursing home, and post-acute facility you need to notify will be on the HIE. You will need additional technology to supplement core HIE and EHRs.

Don’t expect providers to join your network. Some solutions pose a similar challenge by requiring all participants to register as users, providing ADT data only between users on that system. This is problematic given that many PCPs, hospices, SNFs, and other provider facilities won’t have the same technology. If other hospitals in the community use a different solution, PCPs will resist signing up for additional tools.

Ideally, you want a solution that can share information without requiring the recipient to register.
Some care collaboration platforms can share information securely with participants outside their user network, which gives them a unique advantage.

Focus on security. HIPAA compliance is essential for any healthcare solution, but when exchanging patient data between facilities and organizations, security of protected health information (PHI) is particularly critical.

Consider ways to customize clinical data. In addition to required ADT data, PCPs and post-acute facilities will need additional information found in the continuity of care document (CCD). Some niche applications share only basic patient demographics and clinical information without the ability to modify data or add more valuable information.

Ideally, a solution should be able to customize the message to include not only the core ADT information but also actionable data like diagnoses, medications, and care instructions. In fact, CMS has commented that “hospitals might wish to consider ways to fulfill these requirements in ways that reduce redundancy while still remaining compliant with existing requirements. For instance, where appropriate and allowed by law, hospitals might seek to include required necessary medical information within the same message as a patient event notification.”

Look for a solution that streamlines workflows. Accessibility and usability are essential to the use and adoption of any solution. This includes supporting preferred devices (such as smartphones and tablets) and avoiding superfluous log-ins. Automation is another important feature. Some solutions can deliver ADT e-notifications to PCPs and post-acute care providers automatically through a secure link, reducing work for hospital staff and preventing lost documents and PHI exposure.

Seek out multifunction solutions. IT directors and CIOs don’t need to be burdened with another siloed, point solution. Be sure to choose a comprehensive care collaboration platform that can solve multiple problems by providing not only e-notification and data transfer capabilities but also a full suite of communication tools, including telehealth, text messaging, electronic document, and more.

Care Collaboration: E-Notifications, ADT Routing, and More

Check out part two of this blog series for five steps to establishing meaningful care coordination that removes barriers, fulfills the requirements of the CMS mandate, and improves outcomes for your patients. Click here to continue reading.

About Todd Thompson, BSN, RN – Clinical Subject Matter Expert
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Todd has been in healthcare for over 22 years, providing leadership and direct patient care in emergency nursing, critical care, and critical care transport. He currently serves as a SME for the Backline team at DrFirst and is a strong proponent for healthcare innovation.