​The January 1, 2017, deadline for hospitals with more than 50 beds to participate in certain patient safety or quality improvement programs in order to contract with a qualified health plan is less than two weeks away. The final rule, issued in March 2016 by the U.S. Department of Health and Human Services (HHS) under the Patient Protection and Affordable Care Act (PPACA), requires hospitals with more than 50 beds to participate in one of several existing HHS programs, such as patient safety organizations (PSOs) listed by the Agency for Healthcare Research and Quality. Organizations not working with a PSO are required to implement an evidence-based initiative to improve healthcare quality through the collection, management, and analysis of patient safety events; the initiative must reduce all-cause preventable harm, prevent hospital readmission, or improve care coordination. HHS notes that if a provider undertakes activities to improve patient safety and healthcare quality, but does not do so in conjunction with a PSO subject to the requirements of the Patient Safety and Quality Improvement Act (PSQIA) and its implementing regulation, the patient safety and quality information involved in such initiatives would not be subject to PSQIA's privilege and confidentiality protections. Additional requirements include the presence of "a quality assessment and performance improvement program" and discharge planning. The rule, which is effective for plan years beginning on or after January 1, 2017, places the burden of demonstrating compliance on health plans, which are directed to gather documentation from participating hospitals.

HRC Recommends: Health plans contracting with affected hospitals may ask for attestation that they are participating in programs such as PSOs to satisfy the PPACA requirement. ECRI Institute is also aware of health plans that have included contract language requiring hospitals to participate in a PSO or other collaborative even apart from the PPACA requirement. Organizations should review all contract language and be aware of whether such language is included. ECRI Institute PSO can help organizations not already working with a PSO comply with the rule and drive patient safety improvements. Hospitals that are not part of a PSO should determine who in their organization will be responsible for leading that effort or an acceptable alternative under the final rule and how they can use these programs to contribute to improved patient safety throughout their organizations.