A new proposed CMS rule would require hospitals participating in Medicare and Medicaid to once again report respiratory illness data to CDC's National Healthcare Safety Network (NHSN), data the agency hasn't collected since 2020.

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Background

NHSN was established in 2005 to track infections that occur in health care settings. During the early days of the pandemic, health officials, including Deborah Birx, the White House Coronavirus Task Force coordinator at the time, grew frustrated with NHSN's slow data tracking, current and former health officials told Bloomberg.

On July 13, 2020, Sherry Berger, who at the time was CDC's COO, sent an email to a group of U.S. health officials saying, "While NHSN does receive daily data, there are challenges with making rapid changes or additions to the system's data elements."

Berger added that, "In order to allow you the flexibility you need, CDC's recommendation is to move forward with a system other than NHSN at this time." Ultimately, the Trump administration elected to switch to TeleTracking, an outside source, to track hospital data, and NHSN began collecting data from 15,400 nursing homes, Bloomberg reports.

CDC aims to resume data collection

According to a draft of a CMS rule obtained by Bloomberg, which is expected to be made public at the start of April, 6,200 hospitals participating in Medicare and Medicaid, as well as rural critical access hospitals, will be required to electronically report data on respiratory illnesses to NHSN.

That data will also include demographic data regarding a patient's vaccination status as well as their race, ethnicity, gender, age, and health conditions, Bloomberg reports.

The rule would also require hospitals to send NHSN data on protective equipment, ventilators, dialysis machines, ICU beds, and staff shortages, according to Bloomberg.

The change comes amid criticism that CDC has failed to collect, analyze, and report Covid-19 data in a timely and transparent way, Reuters reports.

Reaction

Beth Blauer, who runs the Pandemic Data Initiative at Johns Hopkins University, said the proposed rule would mark a "big shift" and "a reconstruction of trust in the CDC."

"There's concern that when the pandemic emergency lifts, the data flow will dry up," Blauer said. "This is what [CDC was] designed to do."

Kyle McGowan, former CDC chief of staff, said health officials like Birx were "rightfully frustrated" by NHSN in the early days of the pandemic, but argued the blame lies in a law known as the Paperwork Reduction Act, which requires CDC receive certain approvals before they can make changes to data collection. CDC also doesn't have the authority to require hospitals to report data through NHSN, McGowan added.

"People are throwing the CDC under the bus for not having this information daily, but it wasn't given the enforcement mechanisms to be able to," McGowan said. "The CDC has never been given the tools to do its job. The CMS rule is needed and will help them do that job."

However, some experts and health officials expressed concerns about the proposed changes.

"There are just no signs that any thought has been put into how the CDC can raise its game enough to allow for real-time sharing of information that informs the public beyond just the federal government," said a Biden administration official who spoke to Reuters on condition of anonymity.

"If CDC's NHSN system is responsible for collecting pandemic data in the future, it will inevitably fail and put the nation at risk," said Jose Arrieta, chief information and data officer at HHS in 2020.

"While they're trying to turn a Model T into a Tesla, the nation will be suffering," Arrieta added. "NHSN is not flexible enough technically to collect the data." (Griffin, Bloomberg, 3/14; Steenhuysen/Taylor, Reuters, 3/14)