Critical Data and Shutdowns

“Non-essential” services are healthcare data services upon which providers come to rely.

EDITOR’S NOTE: A second government shutdown remains a possibility if a group of bipartisan lawmakers fails to reach an agreement by Feb. 15 on a border security funding package that would avoid a veto from President Trump.

Here is a post from the Centers for Medicare & Medicaid Services (CMS) website during the recent partial government shutdown:

Powell3.jpg

What happens when the government shuts down? What happens when the government partially shuts down? There are long-term and short-term impacts. There are lingering impacts.

We just ended the longest shutdown in federal government history. Another deadline is looming.

During a temporary shutdown, “essential” government services continue while non-essential services are stopped. What are “essential” government services?

Essential services mean “services, by whomsoever rendered, and whether rendered to the Government or to any other person, the interruption of which would endanger the life, health, or personal safety of the whole or part of the population.”

There is a lot of interpretation to be had here. Social Security checks will go out. Medicare claims would almost certainly be paid, but could be deemed non-essential. Enrollment services are not usually deemed non-essential. If someone who qualifies for Medicare but can’t enroll during a shutdown and waits to go to the hospital and dies from lack of care, are enrollment services then considered “essential?” My personal view is that they are. 

You could argue under the Emergency Medical Treatment and Labor Act (EMTALA) that hospitals would have to provide care for this patient. Should people who qualify for Medicare but can’t enroll during a shutdown take the risk that Medicare will back-date their eligibility?

After a month of the government being shut down, my other question on lingering impacts is this: how long will it take for non-essential services take to catch up after a shutdown? Imagine if you stopped going to work for a month. What would the backlog on your desk look like?    

Business runs on data. Included in “non-essential” services are the healthcare data services upon which providers come to rely. Here is a partial list of healthcare data the federal government provides:

  • Hospital Compare datasets
  • Nursing Home Compare datasets
  • Renal Dialysis Compare datasets
  • Updates to the National Provider Identifier datasets
  • Part B provider data
  • Medicare Advantage enrollment data
  • Fee-for-service enrollment data
  • Patient Protection and Affordable Care Act enrollment data

In terms of lingering impacts, what is the impact on healthcare when providers and suppliers do not get updated data? It is very difficult to say.              

 

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Timothy Powell, CPA, CHCP

Timothy Powell is a nationally recognized expert on regulatory matters, including the False Claims Act, Zone Program Integrity Contractor (ZPIC) audits, and U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) compliance. He is a member of the RACmonitor editorial board and a national correspondent for Monitor Mondays.

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