DLP Dispatch #10
Hello, and welcome to the 10th edition of the Data Liberation Project’s newsletter. Inside: Data liberated from CMS’s Acute Hospital Care at Home program, and a major update of the EPA’s Risk Management Program data.
Liberated: Acute Hospital Care at Home data
Today, we’re releasing new data received via FOIA. The records relate to a healthcare initiative that was launched by the federal government during the COVID-19 pandemic and is gaining popularity with hospitals. To the Data Liberation Project’s knowledge, this is the first time the general public has had access to these records.
In November 2020, the Centers for Medicare & Medicaid Services (CMS) announced a new waiver program, called Acute Hospital Care At Home (AHCAH), aimed at “providing eligible hospitals with unprecedented regulatory flexibilities to treat eligible patients in their homes.”
Before the waiver program, a hospital seeking fee-for-service (FFS) Medicare/Medicaid reimbursements for hospital-at-home care needed to provide each patient with 24/7 on-site nursing services. But with an AHCAH waiver, those requirements are relaxed: “A registered nurse will evaluate each patient once daily either in person or remotely, and two in-person visits will occur daily by either registered nurses or mobile integrated health paramedics, based on the patient’s nursing plan and hospital policies,” according to CMS. (Those aren’t the only requirements to participate in the AHCAH program, but represent the most substantial change.)
When first issued in 2020, waivers were only meant to last for the duration of the COVID-19 Public Health Emergency (PHE). The PHE officially ended on May 11, 2023. The 2023 Consolidated Appropriations Act, however, extended the AHCAH program until December 31, 2024.
On January 27, 2023, the Data Liberation Project — in collaboration with researcher Maddy Varner, then a journalist at The Markup — filed a FOIA request to CMS, seeking all database records representing AHCAH waiver requests received by CMS (and the agency’s processing of those requests), all AHCAH reporting measures submitted by hospitals (with the exception of patient-identifiable information), and all database documentation relevant to those records.
On June 26, 2023, CMS provided a response to this FOIA request. It contained four CSV spreadsheets, corresponding to:
- Tier 1 waiver requests (undated, but likely through mid/late April, 2023)
- Tier 2 waiver requests (undated, but likely through mid/late April, 2023)
- Tier 1 reporting measures (through March 2023)
- Tier 2 reporting measures (through the week of April 10–16, 2023)
(The waiver program is split into two tiers: Tier 1 waivers, available to hospitals that “provided at home acute hospital services to at least 25 patients previously,” and Tier 2 waivers, provided to those that had not. The application for Tier 1 waivers is simpler, and those hospitals have to report their key AHCAH metrics only monthly, rather than weekly.)
The data have limitations — some inherent to the records requested, and others appearing to originate from the way CMS has provided them. CMS also did not provide any documentation relating to the data.
Even so, the DLP’s publication of these records represent the first time that the general public has had access to hospital-level numbers on AHCAH patient volume (as measured by discharges, which have been steadily increasing), “escalations,” and unexpected deaths.
To access the records and learn essential context about them, please visit our main documentation for the data.
(Many thanks to DLP volunteer Julia Kieserman for her contributions to the documentation.)
EPA Risk Management Program data updated
Last month, the Environmental Protection Agency indicated that it would soon be able to produce updated versions of its Risk Management Program database in response to FOIA requests. (Previously, the database had been frozen in its March 2022 version, apparently because of a database migration.) The Data Liberation Project filed such a request almost immediately.
A few weeks ago, the records arrived. They cover all submissions through June 2023. The Data Liberation Project has now finished processing them (they were provided in a slightly different format than before), and yesterday published them for all to use. The documentation, simplified spreadsheets, and viewer have been updated accordingly.
The update adds approximately 200 new facilities, 2,600 new RMP submissions (as well as updates to prior submissions), and 160 new accidents.
That’s all for now! Thank you for reading, and don’t hesitate to reply. Alternatively, fill out the volunteer form and/or suggestion form.
— Jeremy