Article
A growing problem in plain view
A KFF Health News report published April 24 describes patients admitted to the hospital but held for days in emergency departments while they wait for a bed. The Joint Commission has called boarding a serious public health crisis. A January 2025 report from the Agency for Healthcare Research and Quality linked it to higher mortality, more medical errors and longer stays. Research by Adrian Haimovich of Beth Israel Deaconess found that boarding over 24 hours rose sharply for patients 65 and older after the pandemic.
The causes reach well beyond the ED. The report points to fewer staffed beds, scheduling that favors elective admissions, and long waits to discharge older patients to rehabilitation or hospice. The American Hospital Association has said root causes include bed costs and post-acute shortages.
The measure that is coming
CMS finalized the Emergency Care Access and Timeliness measure in its 2026 outpatient payment rule. Reporting is voluntary in 2027 and mandatory in 2028, with payment determination effects beginning in 2030. The measure flags ED visits with any of four problems: more than 60 minutes from arrival to a treatment space, leaving without evaluation, boarding more than four hours after the decision to admit, or a total ED stay longer than eight hours. Results will be stratified by age and mental health diagnosis.
Where to start
- Baseline now: Pull your current performance on all four thresholds, including behavioral health patients.
- Own it at the top: Treat boarding as a hospital-wide capacity issue led by operations, not an ED metric.
- Attack discharge delays: Track avoidable days for patients waiting on post-acute placement, and work with skilled nursing and rehab partners on faster acceptance.
- Smooth elective demand: Review surgical scheduling patterns that crowd out emergency admissions midweek.
- Report to the board: Add boarding hours to the quality dashboard so trustees see the trend before CMS publishes it.
Archive entry for Apr 24, 2026, added Nov. 11, 2026.