Health insurance exchange plan offerings may not be an option for hospitals that fail to contract with qualifying patient safety organizations by the federal deadline. But hospitals are still waiting for CMS to clarify the complex regulation.
A brief and little-known provision in the health reform law says any hospital with more than 50 beds will be shut out of the 2015 health insurance exchange plan offerings if it doesn't have a contract with one of 77 federally approved patient safety organizations. Few have these contracts now.
While the Patient Protection and Affordable Care Act provision takes effect with exchange plans as of January 1, 2015, for planning purposes, hospitals will have to meet requirements long before health plans release their offerings three months earlier, on October 1, 2014.
The problem for hospitals is that information they need from The Centers for Medicare & Medicaid Services—information that is material to the complex PSO regulation—has not been released, and hospitals do not know when they can expect it.
"My fear is that hospitals will be caught by surprise to know that they have to contract with such an organization, other than those with whom they might already have a contract, and not have sufficient time to do that," says Nancy Foster, vice president for quality and patient safety policy for the American Hospital Association.
"While October 1, 2014, is when the new plan offerings will arrive, in order to create a contract and report to whatever authority that you have to contract, and have that recognized so you can be part of a (heath plan's) offering, that will take several months," she said.
As defined by the Patient Safety Act of 2005, qualifying patient safety organizations or PSOs are able to confidentially aggregate reports from providers about medical errors, patient harm, near misses, and other adverse events from multiple healthcare settings without fear of legal discovery, to encourage honest discussions of how these events could be prevented. The effort is also meant to help quantify the frequency of incidents that in any one hospital may be extremely rare.