CMS's Emergency Care Access & Timeliness measure counts admitted patients who board in the ED for more than 4 hours.
4 hours
of ED boarding before CMS's measure counts it
CMS's Emergency Care Access & Timeliness measure counts admitted patients who board in the ED for more than 4 hours.
It also counts ED stays over 8 hours, waits of more than 1 hour for a treatment room and patients who leave before evaluation. Hospital reporting is voluntary in 2027 and required from 2028.
Source: CY 2026 Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center final rule, 90 FR 53448 (opens in a new tab), Section XV.B.1.b, Measure Overview, and XV.B.1.c, Measure Calculation. Verified October 2026.
Related charts
- From the blog
A TEAM hospital in Track 3 can owe CMS up to 20% of its total target price in a year
CMS, TEAM Model Overview slides (updated September 2026); 42 CFR 512.550, TEAM reconciliation (eCFR) - From the blog
A boarded med-surg stroke patient cost nearly twice as much a day as one on a ward
Canellas et al., Annals of Emergency Medicine, vol. 84 (2024) - From the blog
Hopkins assigned ED patients a bed 30% faster after opening a command center
Johns Hopkins Medicine, Capacity Command Center news release (October 2016) - From the blog
At the median TEAM hospital, the hospital stay uses 38% to 70% of the target, by surgery
Kent Applied, TEAM position report and method; CMS, TEAM PY1 preliminary target prices; CMS, Medicare Inpatient Hospitals by Provider and Service, 2024; CMS, TEAM episode construction specifications; CMS, payment standardization method; CMS, TEAM model page
Sources for the figures above: 42 CFR 512.550, Reconciliation process and determination of the reconciliation payment or repayment amount (opens in a new tab); Canellas MM et al., Measurement of Cost of Boarding in the Emergency Department Using Time-Driven Activity-Based Costing, Annals of Emergency Medicine 84(4) (opens in a new tab); The Johns Hopkins Hospital Launches Capacity Command Center to Enhance Hospital Operations (news release) (opens in a new tab).
Related facts
30%
faster bed assignment for admitted ED patients
Johns Hopkins reported in 2016 that its new capacity command center assigned beds to admitted ED patients 30% faster.
Source: The Johns Hopkins Hospital Launches Capacity Command Center to Enhance Hospital Operations (news release).
KentApplied54%
of 195 emergency physicians surveyed reported violence tied to boarding
In a 2025 survey of 195 emergency physicians, published in Health Affairs Scholar, 54% reported experiencing violence related to emergency department boarding.
Source: Norton, Schreyer and Kuhn, Workforce impact of emergency department boarding, Health Affairs Scholar 3(8).
KentApplied$1,856
a day per boarded med-surg stroke patient
A 2024 Annals of Emergency Medicine study estimated that boarding a med-surg stroke patient in the ED cost $1,856 a day, against $993 for the same patient on a ward.
Source: Canellas MM et al., Measurement of Cost of Boarding in the Emergency Department Using Time-Driven Activity-Based Costing, Annals of Emergency Medicine 84(4).
KentApplied
Sources for the figures above: The Johns Hopkins Hospital Launches Capacity Command Center to Enhance Hospital Operations (news release) (opens in a new tab); Norton, Schreyer and Kuhn, Workforce impact of emergency department boarding, Health Affairs Scholar 3(8) (opens in a new tab); Canellas MM et al., Measurement of Cost of Boarding in the Emergency Department Using Time-Driven Activity-Based Costing, Annals of Emergency Medicine 84(4) (opens in a new tab).
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