Patient Safety Reporting & Healthcare Payouts

March 8 – 14 was the patient safety awareness week, and as we at Nalashaa look deeper into our goal – accountable healthcare; we will be understanding Patient Safety Reporting in this post.

Patient safety event reporting is one of the quality improvement requirements as mandated by the Affordable Care Act (ACA).  At a Senate hearing last year, patient safety officials brought forth numbers to be discussed and a possible solution for the unknown crisis at hand.

When a patient visits a hospital and subsequently dies, it is very difficult to determine the exact cause of the death, as in most cases, it becomes attributed to the patient illness. But, there is a chunk which is not so, rather is a case of system failure.

The ACA has mandated that hospitals with over 50 beds need to meet certain patient safety standards to be able to contract with a Qualified Health Plan (QHP), through the state health insurance exchange (HIX) by 2017. ACA has proposed to phase in these changes and bring in a more patient safe environment via a phased manner.

Patient safety event reporting is the start point for quality measurement and ensuring patient safety. Understanding and acting upon these reports will help to assess hospital quality concerns. As per the Agency for Healthcare Research and Quality (AHRQ), the following are essential for effective and actionable incident reporting.

Key Components of an Effective Event Reporting System

• Institution must have a supportive environment for event reporting that protects the privacy of staff who report occurrences
• Reports should be received from a broad range of personnel
• Summaries of reported events must be disseminated in a timely fashion
• A structured mechanism must be in place for reviewing reports and developing action plans

Phase 1 of Patient Safety standards establishment for QHP issuers

Phase 1 started on January 1, 2015 and consists of patient safety and discharge planning programs.

Let us look into what this phase comprises of:

1. Each hospital with more than 50 beds is required to participate with a listed Patient Safety Organization (PSO) to be eligible to be to contract with a QHP in the coming years. For 2015, hospitals are required to meet safety assurances for participation in QHP by providing CMS Certification Numbers to the plan
2. A quality assessment and performance improvement as specified plan must be in place
3. Discharge planning should be underway as specified
4. QHP reporting for hospitals must consist of the CMS Certification Numbers also
5. QHP issuers of multi- state plans must ensure the hospitals submit the CMS Certification numbers for all hospitals falling into the above said criteria

The above criteria will be applicable for all plan years beginning on or after January 1, 2015. This first phase of implementation would be for 2 years or until the CMS issues further regulations. These 2 years will allow enough time for the exchange markets to grow, QHP provider networks to grow and also for PSOs to research regarding more effective means for patient safety.

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