Hospitals Lagging on PSO Contracts
Laurie Cohen, a partner in the health practice group for the law firm, Nixon Peabody LLP in New York City, says that in her conversations with providers, "plenty of health plans…are unaware of this requirement. This is not on the front burner for them.
"I'm waiting to see if health plans, at some point, will think that this provision will interrupt their network adequacy." It may be, she says, that an insurance company contracts with a hospital to provide services to Medicare Advantage, regular Medicare beneficiaries, and commercially-insured enrollees "but will have to disassociate with that hospital" in exchange plan offerings.
Officials with Americas Health Insurance Plans declined comment.
However, some approved patient-safety organizations are trying to get out the word. One of the oldest, the national ECRI Institute, sent out this e-mail recently in an effort to recruit hospitals:
"The Challenge: The Affordable Care Act has Patient Safety Organization(PSO) requirements. Starting January 1, 2015, a hospital with 50+ beds can only participate in a Health Insurance Marketplace (aka health insurance exchanges) if the hospital has a Patient Safety Evaluation System (PSES) in place.
"The Solution: The time is now for PSO participation—the deadline is looming. Although 2015 may seem a ways off, it is not. ECRI Institute PSO can help you establish your Patient Safety Evaluation System."
ECRI's Executive VP and General Counsel, Ronni P. Solomon, said the organization "is thoroughly prepared" with a scalable program to accommodate large numbers of organizations.
"In fact, the more the merrier, because that means more data to share and learn."
Cheryl Clark is senior quality editor and California correspondent for HealthLeaders Media. She is a member of the Association of Health Care Journalists.
- How Top-Ranked MA Plans Earn Their Stars
- Readmissions: No Quick Fix to Costly Hospital Challenge
- How Hospitals Can Become 'Upstreamists'
- 4 Ways to Lower the Cost to Collect from Self-Pay Patients
- House Calls Key to Pioneer ACO Success
- How Telehealth Pays Off for Providers, Patients
- 4 Tips for Managing Employed Physicians
- WellPoint Dominates Nearly Half of Markets, AMA Says
- Defensive Medicine Still Prevalent Despite Tort Reform
- CMS Offers Some ACOs $114M for 'Upfront' Costs