Letter to Gene Dodaro, Comptroller General of the United States, - DeGette, others call on GAO to investigate Trump administration's changes to hospital-capacity-reporting system

Letter

Dear Mr. Dodaro:
As our nation continues to face the coronavirus disease of 2019 (COVID-19) pandemic, it
is crucial that we rely on science, public health expertise, and quality data to inform the nation's
actions. Unfortunately, the Trump Administration continues to undermine COVID-19 response
efforts by sidelining scientific and public health experts and threatening the quality of COVID19-related data. The U.S. Department of Health and Human Services's (HHS) introduction of
new and potentially duplicative hospital capacity reporting requirements is yet another example
of this concerning trend. Not only have HHS's actions seemingly sidelined the nation's top
public health officials, but they have also reportedly led to unnecessary confusion, additional
burden on critical COVID-19 response professionals, and the loss of timely and reliable data, all
in the midst of the pandemic when people's lives are at stake. We are concerned that these
reporting changes undermine the nation's COVID-19 response efforts, and therefore request that
the Government Accountability Office (GAO) review the process and impacts of these changes.
Throughout the response to the pandemic, the Trump Administration's guidance and
hospital capacity reporting requirements and systems for key COVID-19 metrics have frequently
shifted, requiring hospitals, and in some cases states, to collect and submit new information
through different platforms with little to no advanced notice. On March 29, Vice President
Pence requested hospitals report daily through the Centers for Disease Control and Prevention's
(CDC) new National Healthcare Safety Network (NHSN) COVID-19 hospital module.
1 The
following week, HHS Secretary Azar sent a letter to hospital administrators introducing a new
third-party reporting mechanism through TeleTracking Technologies, Inc. (TeleTracking), which had been awarded a $10 million, six-month contract on April 6.
2
In addition to introducing these
new mechanisms, HHS also continued to issue new reporting requests--including an abrupt
reversal of new requirements--tying hospital eligibility for access to certain COVID-19
treatments in the subsequent weeks and months to data submission.
3

On July 10, HHS released new guidance removing CDC's NHSN from the reporting
process and requiring hospitals to instead submit data daily either through the TeleTracking
platform or state health agencies authorized by HHS.
4
In testimony before Congress on July 31,
2020, CDC Director Redfield stated that CDC was not involved in this decision and that he was
informed of the change only after it was made.
5 We are concerned these repeated changes to
reporting efforts represent yet another attempt by the Trump Administration to sideline CDC
during the national public health emergency.
These reporting changes raise a number of further concerns. When HHS issued its July
10 guidance removing NHSN as a reporting option, HHS noted that 85 percent of hospitals had
been submitting COVID-19 data through NHSN,
6 and therefore the vast majority of hospitals
had to change reporting platforms. In addition, the guidance required that entities report
additional detailed data variables that were not previously requested.7
After this guidance was
issued, several state health officials raised concerns about the "additional burden placed on hospitals" and that the short turnaround to comply ""could very easily impede patient care and
patient flow.'"8

In briefings with Committee staff, experts have also suggested that the new data reporting
process may erode the quality of data, in part because the system is overly cumbersome and was
developed without input from end users, including public health experts. It also remains
unknown if or how data are being validated, with reports indicating that "there is a data
consistency and quality problem."9
Past and current members of the Healthcare Infection
Control Practices Advisory Committee recently echoed these concerns, warning that retiring
NHSN--a system that ensures national standardization and data integrity--"will have serious
consequences on data integrity."10
Additionally, stakeholders have suggested that the new federal process may come at the
expense of state and local planning efforts. Reports indicate that access to key indicators has
been delayed by the transition.
11 Further, states no longer receive CDC analyses of the data, nor
have consistent access to data submitted to the federal government, both of which they
previously relied on to inform their pandemic response planning.
12 While HHS has stated CDC
will have access to the data that is made available in HHS Protect, in bypassing CDC, the new
reporting processes raise transparency concerns around how the data may be reviewed and its
vulnerability to manipulation to hide the severity of the pandemic.
13
In light of these concerns, to the extent relevant information and data are available in a
timely manner, we request that GAO review the following:
1. What benefits or challenges did changes to the COVID-19 hospital capacity reporting
guidance and systems have on the nation's COVID-19 pandemic response including the
health care system, public health stakeholders, patient care, and access to treatment? In
particular, please address:What effect, if any, did reporting changes have on the ability of federal, state, and
local health departments as well as hospital systems to access data and conduct
planning and analysis?
b. What, if any, burdens did the reporting changes place on hospital staff and
networks, including but not limited to smaller, rural, and tribal hospital systems?
c. What, if any, communication or assistance was provided to hospital staff during
the transition to the new reporting system and what ongoing support, if any,
remains?
d. How, if at all, was ongoing work of public health epidemiologists and researchers
impacted by the guidance and system changes?
e. How, if at all, did reporting changes affect patient and community care and
treatment?
f. How, if at all, did the reporting changes impact the distribution of authorized drug
products for COVID-19 and medical supplies, including personal protective
equipment and ventilators?
g. How, if at all, has HHS addressed any of these challenges or adapted based on
these impacts?
2. How has the Administration monitored, tracked, and aggregated data collected and
compiled through various mechanisms including NHSN, TeleTracking, state-based
reporting, and the HHS Protect platform, and further ensured quality control, utility, and
transparency of data collected from hospitals and others on COVID-19 cases and hospital
resources? Please incorporate the following questions into the review:
a. For which federal programs or activities are these data being used? For example,
how are these data being used to determine federal funding or medical supply
allocations for hospitals, state, and local jurisdictions?
b. How, and to what extent, are these data shared, if at all, among various federal
agencies and with state and local public health authorities?
c. What plans, if any, does HHS have to make the data available to the public and
researchers and in what formats or platforms?
d. How, and to what extent, is HHS overseeing these data collection mechanisms
and the HHS Protect platform to ensure data quality? For example, what
analyses, if any, is being conducted to determine the uniformity, completeness,
and accuracy of the data being collected through TeleTracking and states, and are
these analyses being conducted internally or externally?
e. What is known about any differences in data quality between the hospital data
collected by NHSN prior to July 10, 2020, the data collected through the
TeleTracking system, and the data within HHS Protect thereafter, including any
analyses to determine the uniformity, completeness, and accuracy of such data?
3. What was the timeline and process for the decisions that led to removing NHSN as a
reporting option and limiting future reporting options to TeleTracking and authorized
state-based reporting in July 2020? As part of this review, please address:
a. How have reporting mechanisms and any reporting instructions or guidance
evolved over time since Vice President Pence requested data from hospitals on
March 29, 2020?
b. Who was consulted, both internally within the Administration and externally, for
input into changes to the reporting mechanisms and guidance and what were their
recommendations? In particular, who was involved in the TeleTracking award
decision?
c. What Paperwork Reduction Act approval was sought and granted by the Office of
Management and Budget for the new NHSN COVID-19 module, TeleTracking,
or the state-based reporting mechanism, as applicable? Please explore if any
exemptions or irregularity in the approval process occurred. If so, who was
involved in the process or determination?
d. What analyses, if any, were done to justify transitioning reporting from NHSN to
TeleTracking and authorized state-based reporting? Further, what assessment, if
any, was done to analyze the financial and resource impact of such transition on
hospitals systems and state and local health departments?

Thank you for the timely attention to this request. Understanding that this evaluation
may need to be completed in a series of briefings and reports, we request that GAO provide a
projected timeline as soon as possible of what questions are likely to be addressed within 90,
180, and 365 days. For any questions regarding this request, please contact Jesseca Boyer,
Manmeet Dhindsa, Kimberly Espinosa, and Jon Monger of the Majority Staff at (202) 225-2927.

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