How Do PSOs Enhance Patient Safety?

Working with healthcare providers, PSOs encourage a culture of safety and help improve patient safety and quality care. To do so, PSOs provide several key services. They analyze patient safety event data, which healthcare organizations submit voluntarily, to provide feedback that encourages learning and minimizes patient risk. PSO members benefit from legal protections for the information they share. The Agency for Healthcare Research and Quality requires organizations meet the requirements of the Patient Safety and Quality Improvement Act before getting listed as a PSO.

Legal Consideration

Along with expanding health coverage, the landmark Affordable Care Act (ACA) also highlights the important role of Patient Safety Organizations (PSOs) in assisting hospitals with enhancing patient safety and quality care.

To define the role of PSOs, the Centers for Medicare & Medicaid Services established patient safety requirements for hospitals contracting with a Qualified Health Plan (QHP), an insurance plan certified by the Health Insurance Marketplace.

A CMS rule (45 CFR 156.1110) effective Jan. 1, 2017 states a QHP issuer can only contract with a hospital with more than 50 beds if the hospital takes one of the following two actions: 

• Works with a PSO
• Meets the reasonable exception criteria 

Hospitals choosing the exception must implement their own evidence-based initiatives to reduce all-cause preventable harm, prevent hospital readmission, improve care coordination, and improve healthcare quality through the collection, management and analysis of patient safety events.

CMS notes that the use of a data-driven approach, analytic feedback and shared learning to advance patient safety, such as working with a PSO, is essential to implementing meaningful interventions to improve quality care.

On August 28, 2024, CMS published a new Patient Safety Structural Measure (PSSM) for acute care hospitals. This measure is included in the Medicare/Medicaid/CHIP Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes for Fiscal Year 2025 final rule.

The PSSM is an attestation-based measure comprised of five domains that include 25 patient safety practices hospitals will certify that they implement. Domain 4, patient safety practice B: “Our hospital voluntarily works with a Patient Safety Organization…” emphasizes the importance of the hospital-PSO relationship. Starting in FY 2027, payment for healthcare services will be reduced for hospitals that do not submit their attestation responses. The score will be publicly reported through Care Compare on Medicare.gov starting in October 2026. 

Key PSO Terms

Patient Safety Work Product (PSWP) 

PSWP is the information protected by the privilege and confidentiality protections of the Patient Safety Act and Patient Safety Rule. All PSWP must serve to improve patient safety, healthcare quality or healthcare outcomes. 

Confidentiality Exception

The Patient Safety Rule outlines exceptions to PSWP confidentiality. Disclosures can only occur between a provider and PSO, a contractor of a provider or PSO, among affiliated providers, or to another PSO or provider. Other instances of potential disclosure include during criminal proceedings, for research or business operations, to law enforcement, and voluntary disclosure to an accrediting body. The complete list of confidentiality exceptions is in Section 3.206 of the Patient Safety Rule. Any other disclosure of PSWP is not allowed and subject to penalty. 

Patient Safety Evaluation System (PSES)

PSES is the collection, management, and analysis of safety-related information reported to or by a PSO. A PSES includes all of an organization’s patient safety-related activities in which they identify, assess, investigate, document, analyze, report and communicate safety event information and their improvement efforts. A healthcare organization’s PSES has a fundamental role in determining what can and cannot become PSWP. Many PSO members operationalize the many aspects of their PSES in a policy. 

Patient Safety Activities

Required PSO activities that are performed for its members:

1. Efforts to improve patient safety and quality care
2. Collection and analysis of PSWP
3. Development and dissemination of information regarding patient safety, such as recommendations, protocols or information on best practices
4. Utilization of PSWP to encourage a culture of safety, provide feedback and assistance to effectively minimize patient risk
5. Maintenance of procedures to preserve confidentiality regarding PSWP
6. Provision of appropriate security measures with respect to PSWP
7. Utilization of qualified staff
8. Activities related to the operation of a PSES and provision of feedback to participants in a PSES

 To learn more about PSOs, contact us at 630-276-5657 or MAPSHELP@team-iha.org.