Four Things Healthcare Providers Should Know About the January 1, 2017 ACA PSO Mandate

The Affordable Care Act (ACA) mandates that after January 1, 2017, hospitals with 50 or more beds may not contract with qualified health plans in insurance exchanges unless the hospital has a Patient Safety Evaluation System (PSES) in place and reports safety data to a Patient Safety Organization (PSO).

Here are four things healthcare providers should know about the PSO mandate:

1. You MUST have a Patient Safety Evaluation System in place. The ACA mandate requires providers to set up Patient Safety Evaluation Systems to report patient safety work product to the PSOs. The legislation defines a Patient Safety Evaluation System (PSES) as the “collection, management, or analysis of information for reporting to or by a PSO” (Patient Safety Rule). Providers should use their PSES to take inventory of their patient safety information to determine what can and cannot become patient safety work product to be reported to the PSO.

2. You should choose a federally listed PSO. A health care provider can only obtain the confidentiality and privilege protections of the Patient Safety Act by working with a federally listed PSO.  Federally listed PSOs are governed by the Agency for Healthcare Research (AHRQ). Currently, the AHRQ has more than 80 PSOs in 28 states listed. Providers should choose the PSO from the AHRQ list that best meets their needs.

Here are a few things providers should consider when choosing a PSO:

  • AHRQ Listing: Choose a PSO that is “listed” with AHRQ to ensure that the privilege and confidentiality protections of the Patient Safety Act apply. You can find an updated listing of PSOs on the AHRQ website. You can also find PSOs that have been delisted for not meeting the requirements of the AHRQ here.
  • Data Collection Format Requirements: PSOs are required to collect data in a standardized format. AHRQ has created common data formats for PSOs. However, their formats are not mandatory. Disparate risk management and patient safety systems, different definitions for incidents and near miss events, multiple taxonomies for classifying those events, and unique provider specific data make it difficult for providers to report to PSOs. When evaluating PSOs, make sure you understand their data requirements to ensure your organization can comply with them.
  • PSO Specialization: Based on your needs, you can select a PSO based on region served, specialty (i.e. Cardiology, Internal Medicine, Neurology, Pediatrics, etc.), type of facility served (i.e. Acute Care, Assisted Living, Urgent Care, etc.), number of providers served, number of beds, and resources and services to providers.  Click here to filter PSOs based on your organization’s needs.
  • PSO Services: PSOs offer different levels of service. Some PSOs offer one-on-one consultation with external experts, networking opportunities, toolkits, and other training and resources. Compare services and offerings closely.

3. You may need technical expertise and support to properly submit data to your chosen PSO. Once a PSO has been selected and you understand the PSO’s data requirements, it is critical to work with a technical expert to ensure you are able to collect the required data, consolidate it into a consistent format, and have the systems in place to properly submit the data to the PSO.  There are many technology solution vendors, such as ClearSight, that offer services and technology to automate the capture and transmission of patient safety events to PSOs. Specialists can also map the data from your disparate systems to the standard format of the PSO.

4. You benefit from sharing information with PSOs. PSOs collect and aggregate data from a large number of providers. The data is analyzed by PSO experts on local, regional and/or national levels to identify root causes of patient safety events. These learnings are shared with providers through education and training programs, recommendations and protocols, and best practices. These learnings provide you with new insights that have never been possible before. This allows you to identify patient safety trends, pinpoint solutions, and prevent future events from occurring to help you improve the quality and safety of patient care while reducing healthcare and malpractice costs.

With the January 1, 2017 deadline quickly approaching, now is the time to take action to choose a PSO, implement a PSES, and get your current system up to par. When choosing a PSO keep in mind specialization, data requirements, and services they provide to ensure that you find the PSO that best meets your needs. Work with a technology expert to collect and transfer your data across disparate systems in a simple, secure, cost effective, automated way to PSOs. In conclusion, the investment of time and resources will be well worth the reward as you gain new insights that allow you to be smarter, create a culture of safety, reduce costs, improve quality of care, and increase patient satisfaction.