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Improving Quality and Patient Safety

For many, one of the health system’s lowest hanging fruits — an item that is easily fixed and will likely result in cost savings and better health outcomes — is patient safety improvement. Right now, our system is fraught with preventable events such as hospital-acquired conditions, surgical mistakes, pharmacy errors, and unnecessary readmission.

The ACA responds to this situation in various ways. First, beginning in 2013, inpatient hospitals with higher-than-expected readmission rates will experience decreased Medicare payments for all Medicare discharges.

In addition, the new Innovation Center at CMS will research, develop, test, and expand payment and delivery arrangements to reduce costs while enhancing quality of care provided to patients.

Beginning in 2011, the Community-Based Care Transitions Program, a five-year Medicare pilot program, will be available to hospitals with high readmission rates. Under the program, hospitals must engage in at least one evidence-based care transition intervention — such as conducting comprehensive medication review and management — targeted toward Medicare beneficiaries who are at high risk for a readmission.

Finally, come January 1, 2015, all hospitals over 50 beds will be required to join a Patient Safety Organization (PSO), and won’t be able to contract with health plans in state insurance exchanges unless the hospital is working with a PSO.

California hospitals are already on their way to compliance. In fact, California Hospital Patient Safety Organization (CHPSO) has been established and is one of the largest PSOs in the nation.

According to the California Hospital Association, the CHPSO will accelerate hospitals’ work towards eliminating preventable harm. Events, near misses, and dangerous conditions can be confidentially reported to CHPSO, which will identify common contributing factors and disseminate to hospitals lessons learned from their and others’ experience. Additionally, administrative penalties can be confidentially analyzed and information provided to hospitals to help avoid future penalties.

Through the CHPSO and other ACA changes, we will soon be able to grab this low fruit and hopefully see dramatic decreases in mistakes, never events, hospital-acquired conditions, and unnecessary readmissions.