When one is admitted to an emergency department, they expect a rapid response and livesaving care. However, for years, there’s been a problem undermining that mission: emergency department (ED) boarding.

Patients and clinicians alike have long complained about significant wait times and crowding in emergency departments, with many feeling like their concerns were not being heard.

Now, the Centers for Medicare & Medicaid Services (CMS) has formally acknowledged this issue. In the Calendar Year 2026 Hospital Outpatient Prospective Payment System (OPPS) Final Rule, CMS introduced a new requirement for hospitals to track and publicly report emergency care access and timeliness data. Crucially, this includes ED boarding times.

This is an important step toward transparency, accountability, and meaningful system-level reform. But how did we get here? In this update, we’ll explain why this requirement could be a real gamechanger.

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What’s Wrong With ED Boarding Times?

ED boarding occurs when patients who have been admitted to the hospital remain stuck in the emergency department because no inpatient bed is available. Sometimes, patients remain in the ED for only a couple of hours; other times, they could be waiting for days.

Needless to say, this shouldn’t be the case. Patients who should be on medical floors, step-down units, or in intensive care units instead wait in hallways, storage areas, or improvised treatment spaces, while emergency departments struggle to remain open to incoming emergencies.

These long waits have real consequences. Research shows that prolonged boarding is associated with higher mortality, missed diagnoses, delayed administration of antibiotics, longer hospital stays, and preventable complications.

Anyone who has worked in an ED can immediately recognize why this is the case. Simply put, everyone in a crowded ED is stretched thin — nurses are forced to manage admitted patients while triaging arrivals, and physicians are tasked with stabilizing boarded patients while new cases come through the door. All the while, patients struggle, as they are in an environment not designed for long-term inpatient care.

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What Does This Rule Change?

The new CMS Emergency Care Access and Timeliness (ECAT) measure is not designed to fix this problem — at least, not yet.

For the time being, all this rule does is require hospitals to systematically track and publicly report key metrics related to emergency care delays and boarding. These metrics include time from arrival to treatment space, completion of a medical screening examination, ED boarding time for admitted patients, and total ED length of stay for discharged patients.

While this might not seem like much, it’s an important first step. By acquiring this information, CMS and others will be able to identify problem EDs and figure out just how widespread this problem really is. 

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Why is This Transparency So Important?

ED boarding is a patient safety issue. By publicly sharing ED boarding times and other key metrics, patients, policymakers, regulators, and more all gain insight into not only whether these systems are breaking down, but in what ways. The public knowledge of this information can, in theory, apply pressure to both legislators and healthcare systems to fix what’s broken and implement broad reforms.

The American College of Emergency Physicians (ACEP) deserves a special thank-you for its persistent leadership and advocacy in bringing this issue to the forefront. Their work helped ensure this requirement was included in the final rule, and the impact of their efforts will be felt nationwide.

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What Are the Next Steps?

Professionals across the industry can agree that this is a fantastic first step. Still, there is still significant work to be done.

Fixing the issue of ED boarding will require cooperation from clinicians, hospitals, administrators, policymakers, and payors. It will require sustained commitment, significant financial investment, and, in many areas, wholescale reform.

That said, the role of CMS in this endeavor cannot be overstated. CMS matters because it provides leverage. As the nation’s largest payor, CMS can influence hospital behavior at scale. By tying boarding metrics to payment and quality frameworks, it shifts boarding issues from “an unfortunate norm” to “a reportable failure that demands action.”

Every patient deserves timely, compassionate, and accessible emergency care. With this new rule, that goal is just a little bit closer.