In a recent blog, Olivia MacDonald writes about a recent publication from the OIG with findings that over 20% of Medicare patients experience adverse events during skilled nursing facility stays, 60% of those events being preventable. Hospitalizations resulting from such events cost the Medicare program an estimated $208 million. She also notes that research by Towson University’s Mary Carter identifies that hospitals have historically made more efforts to understand medical injury than nursing homes and outpatient settings such as doctors’ offices, surgery centers and emergency rooms. The February 2014 OIG report called upon the Agency for Healthcare Research & Quality to collaboration with CMS to compile a list of potentially reportable events for nursing homes.
CMS has issued the final rule (beginning on page 13814) pertaining to the ACA PSO provision requiring larger hospitals to participate with a PSO. The final rule, as expected, delays the PSO participation requirement until at least 2017, instead allowing hospitals to meet safety assurances for participation in Quality Health Plans, that are part of Health Insurance Exchanges, by providing CMS Certification Numbers to the Plans.
In response to the December 2 publication of a proposed rule for the Affordable Care Act Benefit and Payment Parameters, including requirements for Qualified Health Plans (QHP) to meet patient safety requirements, the Center for Patient safety submitted comments along with several other PSOs across the nation. Among other provisions, the rule proposes a two-year delay in the requirement for QHPs to only contract with hospitals that have more than 50 beds if the hospital participates with a PSO as part of its patient safety program. The Center’s comments address concerns about Medicare COPs being a sufficient requirement for patient safety standards during the 2-year delay in light of studies showing greater strides need to be made to reduce error, the need to acknowledge the work of PSOs and organizations that have participated with PSOs and disagreeing with CMS’ assertion that PSOs do not have the capacity to add participants and QHPs would have difficulty confirming compliance.
A proposed rule implementing several provisions of the Affordable Care Act (ACA) has been issued for comment through December 26th. The proposed rule, beginning on page 171, addresses the ACA’s requirement for hospitals to meet patient safety and quality improvement requirements in order to be eligible to contract with a qualified health plan that participates in the new health insurance exchanges. As initially written, Section 1311 of the ACA included a provision requiring hospitals with more than 50 beds, by January 2015, to meet certain patient safety requirements, including using a patient safety evaluation system (PSES). The newly proposed rule clarifies that a PSES is the collection, management or analysis of information for reporting to or by a patient safety organization (PSO). However, the Centers for Medicare & Medicaid also indicate, within the proposed rule, they intend to delay the PSO participation requirement due to several challenges with the 2015 deadline. Beginning in 2015, hospitals will be required to meet current CMS requirements for patient safety and quality improvement while CMS develops further regulation for implementation of the patient safety provisions over the next two years. Comments on the proposed rule are due December 26, 2013.
On March 15, 2013, the Centers for Medicare and Medicaid Services (CMS) released a memo about the Agency for Healthcare Research and Quality’s (AHRQ’s) Common Formats. The memo provides information on the Common Formats and how their use may help hospitals meet the CMS Quality Assessment and Performance Improvement (QAPI) requirements.
Hospitals are required to track adverse patient events as a Condition of Participation (CoP) for QAPI requirements. Although Common Formats use is voluntary, CMS is encouraging surveyors to become familiar with them. CMS states that, “Use of the AHRQ Common Formats by hospitals is not required under the QAPI CoP. We suggest, however, that a hospital that uses the Common Formats and is adept at the analysis that this structured system permits, will be in a better position to meet the CMS QAPI requirements.”
To view the memo, please go to CMS’ Web site at: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/Policy-and-Memos-to-States-and-Regions-Items/Survey-and-Cert-Letter-13-19.html
CMS has released a new online tool to empower consumers to make informed choices about their health care. The Quality Care Finder links consumers with all of Medicare’s compare tools in one convenient location (www.Medicare.gov/QualityCareFinder). Also released is a revised Hospital Compare website with additional data related to outpatient surgical infections and heart attack care (www.hospitalcompare.hhs.gov). Dr. Don Berwick, CMS Administrator, states “These tools are new ways CMS is making sure consumers have… important information they need to make the best decisions about where to receive high-quality care.”
A newly published federal rule requires Medicaid programs to implement non-payment policies for preventable events by July 2012.
The Center will be attending the Regional Symposium on Accountable Care Organizations, Thursday, April 28th at the Tiffany Greens Golf Clubhouse in Kansas City.
The symposium is important because of the great presenters who will be sharing valuable updates, strategies and more.