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ECAT report service · Coming soon

See what ECAT will say about your emergency department

The ECAT Readiness & Shadow Performance Report is being built to do more than calculate a score. It will show which of the four ECAT conditions are shaping your result, when the gaps occur, how much data quality changes the estimate, and where leadership should look first.

Get updates or join the free trial → What's in the report

The ECAT Readiness & Shadow Performance Report service is coming soon. Get launch updates or volunteer for a free early trial.

Shadow ECAT result Synthetic sample
28.6%
↓
of eligible encounters with at least one timeliness gap. Data-clean scenario, 12 months.
Adult 26.1%
Pediatric 19.4%
Adult mental health 47.8%
Pediatric mental health 38.2%

All four CMS strata are reported publicly. Lower is better.

CMS public reporting CMS plans to publish a hospital-level ECAT result.
No exclusions Every eligible encounter counts toward the result.
Four CMS strata Adult, pediatric, and mental health results reported separately.
Data you already have Standard ED timestamps. No new instrumentation.
The measure

What is ECAT?

Emergency Care Access and Timeliness, in plain language.

ECAT is a CMS electronic clinical quality measure for the Hospital Outpatient Quality Reporting program. It is calculated from ED timestamps your systems already record: when patients arrive, when they leave, and what happens in between. Results report across four official CMS strata.

Two things make it different from the ED metrics you already watch. First, the specification has no denominator exclusions or exceptions. Every eligible encounter counts, so incomplete or messy data does not drop out of the calculation. It shows up in your result.

Second, the result is destined for public reporting, which means your board, your competitors, and your community will read it.

Most EDs have never computed the measure the way CMS specifies it. The gap between what leaders assume and what the specification produces is exactly what a readiness analysis exists to close.

The four timeliness components
  • C1
    Access to a treatment spaceNo qualifying placement, or placement more than 60 minutes after arrival.
  • C2
    Left without being evaluated
  • C3
    BoardingMore than 240 minutes from the admit decision to leaving the ED.
  • C4
    Length of stayMore than 480 minutes in the ED, arrival to departure.
One gap on an eligible encounter counts it in the numerator. Boarding and length of stay carry an observation-stay rule; the denominator has no exclusions.
Coming soon

The ECAT Readiness & Shadow Performance Report

We are testing the complete analysis and reporting workflow now. Join the launch list, or volunteer for a free early trial and help us test the experience before the service opens.

Coming soon · Inside the report

ECAT Readiness & Shadow Performance Report

One historical ED extract becomes an estimated ECAT result, a data-readiness assessment, operational pattern analysis, and a set of leadership-ready deliverables. No EHR integration and no direct patient identifiers requested.

Sample pages with synthetic data. Click a page to look closer.

ECAT Readiness Dashboard Concept preview · synthetic data
28.6%Overall any-gap rate
↓ lower is better
47.8%Worst stratum
Adult mental health
C3Largest condition
Boarding
4.9ptsData-quality gap
as-submitted vs clean
By stratum
Adult26.1%
Pediatric19.4%
Adult MH47.8%
Pediatric MH38.2%
When gaps happen
Mon AM24%
Fri PM46%
Sun PM34%
Time blocks shown only when reporting thresholds are met.

Your results live in a personalized dashboard, included with the report.

What you learn

  • Your estimated overall result and each of the four CMS reporting strata
  • Which timeliness conditions, sites, patient groups, and time periods are associated with the gaps
  • How missing or inconsistent data changes the estimate
  • Which findings deserve validation and investigation first

What you get

  • Historical ECAT calculation with placement, LWBS, boarding, and length-of-stay breakdowns
  • Data-readiness findings and a data-clean sensitivity view
  • Site, stratum, patient-group, failure-pattern, and time-of-week analysis
  • An interactive dashboard with statistical association and diagnostic views
  • A 9-page executive PDF and editable 20-slide presentation deck
  • A 45-minute results meeting with a board-certified emergency physician

What it asks of you

  • One historical data pull built from our extraction instructions
  • No EHR integration or installed application
  • Derived durations and limited encounter attributes, without direct patient identifiers
  • Review of the findings with the leaders who own flow and data quality
01

Prepare one extract

Your team follows our extraction instructions to create a historical file using derived durations and limited encounter attributes. The workflow does not request direct patient identifiers.

02

We test the number

The tool validates the file, estimates ECAT performance across all four reporting strata, and shows how data readiness affects the result.

03

Turn the result into a leadership read

We review the dashboard, executive PDF, and editable deck with your team for 45 minutes, focusing on the patterns to validate and the first questions to investigate.

Prepare nowUse historical data to find measurement and operational gaps while there is time to act.
CY 2027Voluntary reporting begins.
CY 2028Mandatory reporting begins, affecting the CY 2030 payment determination.
The engagement

ECAT Readiness & Shadow Performance Report

  • Estimated ECAT performance across all four reporting strata
  • Data-readiness assessment and sensitivity view
  • Site, patient-group, failure-pattern, and time-of-week analysis
  • Interactive dashboard with association and diagnostic views
  • 9-page executive PDF and editable 20-slide deck
  • 45-minute physician-led results meeting
Coming soon Free early trial · Register your interest Get updates or volunteer →

Help us refine the report service before launch. We’ll follow up about trial availability and next steps.

Who you're working with

Two emergency physicians

We built the analysis, we run every engagement, and one of us reads every inquiry. The flow thinking behind it comes from the Theory of Constraints.

BNBenjamin Newman
Benjamin Newman, MD, FACEP Emergency physician · Co-founder
DBDavid Boger II
David Boger II, DO, FACEP Emergency physician · Co-founder
2025
Hosted TOC + HealthcareThe first Theory of Constraints conference dedicated to healthcare. Five tracks, more than twenty sessions on patient flow, from emergency departments and operating rooms to behavioral health.
2025
TOC 101An introduction to the Theory of Constraints, at the TOC + Healthcare online conference.
2025
TOCICO Emerging Talent in TOC AwardDavid Boger II.
2024
TOCICO Outstanding TOC Champion AwardBenjamin Newman and David Boger II.
2024
Blueprinting for FlowIncorporating TOC principles into the design of a new emergency department. TOCICO international conference, Germany; presented again at TOC + Healthcare 2025.
2024
Telemedicine to the RescueUsing TOC to deploy a solution to a critical staffing shortage. TOCICO international conference, Germany; presented again at TOC + Healthcare 2025.
Questions

Before you ask

We already track door-to-room, boarding, and LOS. What does this add?

Your operational dashboards answer local questions. ECAT applies a specific CMS definition across four timeliness conditions and four reporting strata. The readiness report recreates that logic on your historical data, shows where the result comes from, and separates likely operational gaps from data-readiness problems.

Our timestamps are messy. Is that a problem?

Messy timestamps are part of readiness. The tool checks the file before analysis, identifies missing or inconsistent fields, and shows how incomplete records affect the estimate. The report distinguishes the as-submitted result from a data-clean sensitivity view so leaders can see what is operational performance and what is data quality.

Do you need patient identifiers or PHI?

We do not ask for names, medical-record numbers, full dates, or other direct patient identifiers. The planned workflow uses derived durations and limited encounter attributes, with small-cell protections in reportable breakdowns. Final intake instructions and privacy terms will be completed before client launch.

When will the service be available?

The service is coming soon. Sign up for launch updates or volunteer for a free early trial. We’ll confirm timing and next steps with trial participants before any work begins.

What does the early trial cost?

The early trial is free. Participants will help us refine the report service by sharing feedback. Registering your interest does not guarantee a trial place; we’ll follow up about availability and next steps.

You can't fix a number you haven't seen

Our report service is coming soon. Get launch updates or volunteer for a free early trial to help us refine it before launch.

Get updates or join the free trial → See what the report includes
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This page describes a CMS measure in plain language to help ED leaders orient. It is not regulatory, compliance, or legal advice; the CMS specification is the authoritative source for how ECAT is calculated and reported.