Patient safety groups, hospitals await decision on delay in ACA standards

The CMS has yet to make a final call on delaying new safety standards for hospitals that participate in qualified health plans under the Patient Protection and Affordable Care Act.

Under a provision of the law that was supposed to take effect next January, hospitals with more than 50 beds must meet certain patient safety standards, including use of a patient safety evaluation system (PSES) and a comprehensive hospital discharge program, in order to contract with a qualified health plan sold through the new insurance marketplaces.

Hospitals with high readmission rates are asked to work with a federally designated patient safety organization, a group that collects and analyzes data on the risks and hazards associated with patient care, in order to establish a process to improve performance and reduce readmission rate.

At the end of the year, however, the CMS concluded that implementing all of the patient safety requirements by Jan. 1, 2015, “could result in a shortage of qualified hospitals and providers available for contracting.” The agency suggested these rules be implemented over a two-year rollout period, instead. Comments on the proposal ended Dec. 26.

CMS officials said they could not provide a timeline for a final rule.

The proposal was welcome news for hospitals under pressure to join or form a PSO before the deadline, but it sparked concern among groups that fought to make patient safety a priority in the law.

“We are pleased with CMS' plan to phase in these requirements over time” wrote the American Hospital Association in a letter offering support for the CMS suggestion to initiate future rulemaking before implementing robust requirements in a second phase. The AHA noted that the language could be clearer on whether the proposed regulatory text applies to hospitals that do not participate in Medicare or Medicaid, who they say would not be subject to the provision and would have no restrictions on contracting with qualified health plans.

The Center for Patient Safety commented that current Medicare conditions of participation are not “a sufficient requirement for patient safety standards during the two-year delay.”

Patient safety advocates also disagreed with assertions by hospitals and the CMS that PSOs do not have capacity to add participants and that it would be difficult to confirm compliance to the standards.

In the proposal, the CMS said it recognized the important role of nearly 80 patient safety organizations to collect, aggregate and analyze patient safety events and information that is protected under privilege and confidentiality standards. “However,” the agency added, “it is not entirely clear that there is sufficient capacity to enable all hospitals subject to this provision to contract with a PSO at this time.”

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