Hospitals slow to join PSOs; deadline looms
State insurance exchanges and the federal marketplace got off to a rough start at the beginning of October. But there is no reason to believe that the exchanges won't have smoothed out many of the glitches in the next year. And it's doubtful that the requirements of the Affordable Care Act (ACA) will change dramatically in that time. Given those realities, what explains why hospitals with more than 50 beds haven't joined patient safety organizations (PSOs) in larger numbers, given that if they want to participate in state exchanges after Jan. 1, 2015, they will have to be part of one?
"I think there is still a lot of confusion among hospitals," says Nancy Schanz, RN, MA, MBA, MHA, director of the patient safety organization at the (Cary) North Carolina Quality Center. "I think that it seemed like people could wait since it was going to happen way off in 2015. And the rules that initially came out said that we have to have a patient safety evaluation system, but no one knew that what meant. The language on that has not been clear, even when it has been forthcoming."
Schanz says it seems pretty clear that hospitals over 50 beds will have to belong to a PSO, and that a lot of PSOs have been working hard at recruiting those hospitals — including organizations that are not federally certified patient safety organizations, but which think they still could qualify as a patient safety evaluation system, and that hospitals will be able to use membership to participate in a health exchange. She gives an example of the Pennsylvania Patient Safety Authority (PPSA), which isn't certified as a PSO, but does a lot of great quality and safety work. Schanz says the government may develop a way for organizations like PPSA to apply for an exception based on the work it has done in the past.
If there was some impetus to act gathering steam as the year progressed, it ground to a halt during the summer, when the American Hospital Association sent members an advisory that indicated they might be able to participate in exchanges even if they aren't part of a PSO. "My understanding is that there will be some clarification forthcoming," Schanz says.
That means there is still some breathing room for hospitals that haven't climbed aboard the PSO train, she says. "I think it's safe to wait for clarification, but you have to use the time to educate yourselves about what patient safety organizations do."
Look at the PSOs that are out there — Schanz says there are specific PSOs that cover just one thing, such as surgery or emergency services, as well as more generalized PSOs that are better for facilities that are not operating in a specific niche. Check out the costs, which vary. Some are supported by state hospital associations, and provision of services is free. Ask questions and seek opinions, says Schanz. "I think that when we get whatever clarification comes — probably by the end of the year — you will see a strong support from the AHA to belong to a PSO and the pace will pick up again."
Whatever enthusiasm there is for PSOs is predicated on the potential benefits of collecting data and sharing it with others so everyone can learn from it. "PSOs can pick up patterns and trends you can't see with small numbers, and help you come up with ways to mitigate harm and share best practices," says Schanz.
Small and medium-sized hospitals have a lot to gain from participation in a PSO, partly because they don't have the resources and quality infrastructure of large or academic institutions, says Bethany A. Walmsley, CPHQ, CPPS, executive director of the Oregon Patient Safety Commission in Portland.
PSOs were created to collect and aggregate data "in a protected environment for the purpose of accelerating learning among organizations," Schanz says. "This protected environment allows providers to discuss and share information within a culture of safety and thus improve the quality and safety of patient care without fear of reprisal." The act that created them also provided for common formats for reporting, which will aid aggregation and comparison of information and hopefully eliminate the data silos that have limited the usefulness of information in the past. "If hospitals are not collecting the same data with the same definitions, the usefulness of the data is certainly diminished," says Schanz.
"Requiring a hospital to have a patient safety evaluation system makes sense," Schanz notes, "and PSOs are designed just for that purpose. PSOs can provide valuable support and benefits to organizations."
"Familiarize yourself with what is available to you in the PSO market and contact them to find out what joining can offer you," says Walmsley.
A current list of approved PSOs is available on the website of the Agency for Healthcare Research (AHRQ) at http://www.pso.ahrq.gov/listing/psolist.htm. AHRQ is responsible for certifying PSOs and managing the process for becoming one.
For more information on this topic, contact:
- Bethany A. Walmsley CPHQ, CPPS, Executive Director, Oregon Patient Safety Commission, Portland, OR. Email: email@example.com .
- Nancy Schanz, RN, MA, MBA, MHA, Director, Patient Safety Organization, North Carolina Quality Center, Cary, NC. Telephone: (919) 677-4105.