Key Takeaway
The CMS Emergency Care Access and Timeliness (ECAT) measure, which begins reporting in 2028 after a voluntary preview year in 2027, evaluates how reliably hospitals deliver timely emergency care. It combines four indicators: waits over one hour to reach a treatment room, patients who leave before being evaluated, boarding delays over four hours after a decision to admit, and ED stays over eight hours. Most delays stem from inpatient capacity and care coordination, but reservation-based arrival tools like InQuicker can address front-end access barriers that contribute to walkaways, giving hospitals a stronger starting point before reporting begins.
Est. 6 min. read
Hospital leaders already track dozens of emergency department (ED) metrics, from door-to-provider times to boarding delays and patient satisfaction. But as hospitals face growing pressure to improve access and timeliness, these measures are taking on new significance. The bigger question is whether patients are actually getting timely emergency care.
The Centers for Medicare & Medicaid Services (CMS) is helping answer that question. Starting in 2028, a new quality measure will put that question at the center of hospital quality reporting.
What is the CMS ECAT Measure?
Emergency Care Access and Timeliness (ECAT) is a CMS quality measure that evaluates how reliably hospitals deliver timely emergency care. Instead of judging EDs on a set of separate benchmarks, it gives leaders one view of access and throughput.
ECAT tracks four signs that timely emergency care may have broken down:
- Patients who wait more than one hour to reach a treatment room
- Patients who leave before being evaluated
- Boarding delays longer than four hours after a decision to admit
- Emergency department stays that exceed eight hours
ECAT is notable because it is a composite measure rather than four separate performance scores. A patient encounter is counted once, even if multiple delays occur during the same visit. CMS also evaluates performance against peer hospitals with similar emergency department volumes and breaks out results for adult, pediatric, and behavioral health populations.
Why ECAT matters for hospitals
ECAT treats access as a quality issue. Clinical quality still comes first, but patients also judge their experience by how quickly they can start care, whether they know what to expect, and how supported they feel while they wait.
When patients wait too long or leave before receiving care, the consequences go beyond satisfaction scores. Delayed care can affect outcomes, utilization, trust, and retention. A patient who leaves because the path to care feels confusing has an access problem, even if a clinician was ready to see them. ECAT gives executive teams a shared way to evaluate these challenges across facilities and over time, moving throughput out of the ED and onto the broader leadership agenda.
Not every ED delay starts in the ED
Many of the problems ECAT measures begin elsewhere in the hospital. Boarding and long stays usually trace back to inpatient bed shortages, staffing gaps, discharge bottlenecks, and weak care coordination. Even a well-run department may not move those numbers without changes across the organization.
Walkaways are different. No single factor explains why patients leave without being seen (LWBS). But uncertainty, perceived wait times, poor communication, and friction at arrival are common contributors. Hospitals have long treated these departures as lost revenue. A patient comes in for care and leaves without it. Under ECAT, those departures also become a visible sign of a broader access problem.
Can ED scheduling reduce walkaways?
Emergency department scheduling can’t solve inpatient bed shortages, boarding delays, or extended lengths of stay. What it can improve is how patients enter care and what they experience before arrival.
Reservation-based arrival tools allow patients to select estimated treatment times, wait at home until closer to their arrival window, and complete paperwork in advance. This reduces uncertainty, addresses factors that contribute to walkaways, and gives operations teams earlier visibility into demand.
Early data suggests reservation-based arrival can improve patient follow-through and reach new patient populations. Data from one health system using InQuicker, Carenet’s reservation-based patient access solution, showed that 81% of reservations resulted in patients arriving for care, 42% of patients had no primary care provider on file, and 61% were new to the facility. InQuicker also reports that 8 in 10 patients are seen within 15 minutes of their estimated treatment time, with average patient satisfaction scores of 90%.
See how one health system scaled digital ER access to 40 hospitals
While these findings don’t directly establish a reduction in walkaways, they demonstrate the potential to improve patient follow-through, connect with new patient populations, and address front-end access barriers as hospitals prepare for ECAT.
What health systems should do now
The organizations that benefit most from ECAT won’t be those simply chasing a score. They’ll use the measure to identify where patients encounter barriers to timely care and prioritize improvements that make the greatest impact.
With a voluntary preview year in 2027 ahead of reporting in 2028, health systems have an opportunity to get ahead of the measure by:
- Establishing a baseline: Evaluate current performance across ECAT’s four indicators to understand where delays and patient walkaways are most prevalent.
- Identifying the underlying causes: Distinguish capacity and throughput constraints from front-end access challenges that may require different interventions.
- Prioritizing targeted improvements: Address inpatient bottlenecks and care coordination gaps while exploring opportunities to reduce walkaways through clearer communication, digital scheduling, and pre-arrival engagement.
ECAT will make access challenges more visible across facilities and peer organizations. Health systems that act now will be better positioned to understand their performance, address persistent barriers, and deliver a more predictable patient experience.
Improving access before patients arrive
Carenet helps health systems make the path into emergency care clearer and more predictable. With InQuicker, patients can reserve their place in line, know what to expect, and arrive ready for care.
Frequently asked questions
What is the CMS ECAT measure?
The Emergency Care Access and Timeliness (ECAT) measure evaluates how effectively hospitals provide timely emergency care by tracking key indicators such as wait times, boarding, length of stay, and patients who leave before evaluation. CMS introduced ECAT to improve visibility into emergency department access challenges and encourage hospitals to address barriers that prevent patients from receiving timely care.
Can emergency department scheduling improve ECAT performance?
Scheduling can’t fix boarding or capacity limits on its own. It can reduce uncertainty at arrival, help prevent walkaways, and give hospitals an earlier view of demand. There is no benefit or penalty attached to performance in 2027, giving hospitals an opportunity to understand their baseline performance before ECAT reporting begins in 2028. While scheduling is most directly connected to reducing walkaways and improving the arrival experience, it may also support broader patient flow and access goals.
What is InQuicker?
InQuicker is a digital self-scheduling solution that allows patients with non-life-threatening conditions to select an estimated treatment time, check in online, and wait from home until closer to that time. For health systems, it also provides visibility into expected arrivals so teams can better prepare space, staff, and supplies.
How does InQuicker work for emergency and urgent care?
Patients with non-life-threatening conditions can select an estimated treatment time and provide information about their reason for visiting before they arrive. Instead of spending the entire wait in the waiting room, patients can wait at home until closer to their estimated treatment time.
Does InQuicker give patients an appointment time for the ED?
InQuicker gives eligible patients an estimated treatment time rather than a traditional appointment time. Patients can check in online and wait from home until closer to that estimated time.
Can InQuicker help reduce patients leaving before they are seen?
InQuicker is designed to address some of the front-end factors associated with the ED waiting experience by giving appropriate patients an estimated treatment time and allowing them to wait from home. InQuicker also specifically identifies improvement in left-prior-to-medical-screening-exam (LPMSE) rates as an outcome it supports.
