You Have Questions, We Have Answers. September 12, This presentation is co-hosted by:

Transcription

1 PSO? PSES? PSWP? You Have Questions, We Have Answers September 12, 2013 This presentation is co-hosted by: 1

2 Today s Presenters Eunice Halverson MA PATIENT SAFETY SPECIALIST CENTER FOR PATIENT SAFETY Becky Miller MHA, CPHQ, FACHE, CPPS EXECUTIVE DIRECTOR CENTER FOR PATIENT SAFETY Kathy Wire JD, MBA, CPHRM PROJECT MANAGER CENTER FOR PATIENT SAFETY 2

3 Objectives for Today s Session Following this Webinar, participants will be able to: Describe the basics of the Patient Safety and Quality Act of 2005 (PSQIA) Understand the role of Patient Safety Organizations (PSOs) from a national perspective, including implications of the Affordable Care Act Understand steps to develop a Patient Safety Evaluation System (PSES) Learn the definition of Patient Safety Work Product (PSWP) Be familiar with PSO services to assist in safety improvement and reducing harm to patients 3

4 The Center for Patient Safety (CPS) Journey One of the first 10 PSOs to certify with AHRQ in 2008 Serves as a facilitator, convener, educator and central voice on patient safety issues Integrates safety culture and other key aspects of safety improvement Just Culture, CUSP, TeamSTEPPS training Survey on Patient Safety (SOPS) (hospital, medical office, pharmacy, LTC) First in nation to develop services for EMS (culture and PSO services) Integrating Long Term Care PSO services Partnered with VergeSolutions in 2013

5 The Patient Safety & Quality Improvement Act of 2005 (PSQIA) Federal law and regulation Intent of the PSQIA A safe environment supporting reporting, sharing, and learning about medical errors A voluntary approach to proactive prevention of medical errors & patient harm Reduction of healthcare costs from error and patient harm Establishes Common Data Formats for PSOs to collect consistent information from healthcare providers (errors, near misses and unsafe conditions) Resource:

6 Patient Safety Organizations (PSOs) A PSO is a private or public entity federally listed as a PSO by the Secretary of the US Department of Health and Human Services (HHS) Meets criteria for certification Ability to securely and confidentially collect, analyze and report adverse events Required policies and procedures in place Staff meets qualifications Performs patient safety activities More information:

7 How Can the PSQIA and PSOs Improve Safety? PSOs can aggregate data from many providers to identify risk patterns of care and system failure Healthcare providers can be comfortable confidentially reporting medical errors, near misses and unsafe conditions with federal protection from disclosure Providers can work together in a confidential, protected space to share and learn how to prevent mistakes, and, Participating providers are assured that their safety work will not be used against them. 7

8 A National Perspective of PSOs Currently 78 PSOs in 29 states Providers (N=4,371) 1,897 specialized treatment facilities 1,512 hospitals, 311 specialty 438 practitioner groups 34 Long-Term Care 199 other Source: 9/2013 AHRQ Annual PSO Meeting, 4/2013

9 National Interest patient safety events should be reported through the protected environment of federally designated patient safety organization s (PSOs) Potential language in future meaningful use regulations 9

10 National Interest Institute of Medicine, Health IT and Patient Safety, Building Safer Systems for Better Care, 2012 The CMS Partnership for Patients Focus on Reducing Harm The Joint Commission, Improving Patient and Worker Safety 2012 National Association for Healthcare Quality (NAHQ) Call to Action, October 2012 Office of the Inspector General (OIG) Recommendations to CMS Centers for Medicare & Medicaid Services (CMS), Quality Assurance and Performance Improvement (QAPI) Conditions of Participation (COPs) 10

11 Patient Protection and Affordable Care Act (PPACA) Two Provisions Related to PSOs and Hospitals: PSO s to assist high-need hospitals in reducing readmissions (Section 3025) Beginning January 2015, A Qualified Health Plan may contract with: (A)A hospital >50 beds only if the hospital utilizes a Patient Safety Evaluation System; and the hospital implements a mechanism to ensure that each patient receives a comprehensive program for hospital discharges (meeting certain criteria) OR (B)A health care provider only if the provider implements quality mechanisms required by HHS (Section 1311(h))

12 Implications of PPACA, SEC Qualified Health Plans operating through the new Health Insurance Exchanges (HIEs) can only contract with hospitals > 50 beds that have a patient safety evaluation system (PSES) A hospital that utilizes a PSES works with a PSO Enormous incentive for hospitals to work with a PSO no later than January 1, 2015 PSOs are prepared to work with additional hospitals to help them comply with this provision

13 PSQIA Key Provisions Processes Protection for processes Patient Safety Activities Protection of quality and safety discussions and documents Patient Safety Evaluation System (PSES) Patient Safety Work Product (PSWP)

14 Patient Safety Evaluation System (PSES) A PSES is An over-arching umbrella of all your patient safety and quality improvement work Privileged and confidential under the federal PSQIA of

15 Patient Safety Evaluation System (PSES) A PSES is The means, mechanisms or systems your organization uses to collect, manage, analyze and communicate information for quality and safety improvement and for reporting to the PSO 15

16 Patient Safety Evaluation System (PSES) Your PSES may contain information about events, errors, near-misses, quality improvement data, and other patient safety and quality data and information that is developed, investigated, examined, and analyzed by and for your PSES workgroup 16

17 Key Provisions Processes Protection for processes Patient Safety Activities Protection of quality and safety discussions and documents Patient Safety Evaluation System (PSES) Patient Safety Work Product (PSWP)

18 Patient Safety Work Product (PSWP) Data, reports, records, memoranda, analyses, or written or oral statements which are assembled or developed by a provider for reporting to a PSO and are reported to a PSO, or are developed by a PSO for the conduct of patient safety activities, or which identify or constitute the deliberations or analysis of, or identify the fact of reporting pursuant to, a PSES

19 Patient Safety Work Product (PSWP) What is NOT PSWP? Patient s medical record Billing and discharge information Any other original patient or provider record Information collected, maintained or developed separately, or that exists separately from a PSES PSWP

20 Establishing Your PSES Step 1: Identify and assess current event reporting systems and information flow for patient safety and quality improvement activities, considering: Your incident reporting system, including how patient safety events are identified, reported and managed through risk management/ patient safety/quality improvement/customer services/peer review and credentialing processes How this data is shared, processed, documented and maintained (a flowchart of your processes is helpful) Your committee structure where patient safety and quality data and information are discussed/shared 20

21 Establishing Your PSES Step 2: Based on your assessment, determine which of these activities and events will and will not be included in your PSES. (Each organization makes this decision based upon their unique needs.) 21

22 Establishing Your PSES Step 3: Identify and define the scope and function of your PSES in your PSO policy. (Your PSO should have a template or other resources to assist you.) 22

23 Key Concepts Everything you define as being under the umbrella (PSES) is legally protected and confidential at the time the documents are created. You do not need to report/submit EVERYTHING inside your PSES to the PSO, but you need to submit SOMETHING to show you are actively involved in a PSO. 23

24 Getting Started Ask Can my organization benefit from Learning from others about causes of medical mistakes and near misses and how to prevent them? Obtaining federal legal and confidentiality protections to supplement peer review and attorney-client privileges for quality and safety improvement work? What type of PSO would best meet my organization s needs? 24

25 Getting Started Contract with a PSO that meets your needs and can best help Assess quality and patient safety information workflows Develop PSES and PSWP policies Implement confidentiality processes Submit, report & analyze patient safety events 25

26 The PSO Social Contract PSO s pledge to provide a safe environment in which to report and discuss adverse events, and share the learning obtained from the reporting Healthcare providers pledge to report complete and accurate information about adverse events, near misses and unsafe conditions to the PSO to feed the learning Together, healthcare providers and PSO s pledge to focus efforts collectively on improving the safety of care and preventing harm for all patients

27 Why Participate in a PSO? Participate in sharing and learning aimed at preventing medical error and patient harm Collaborate with others to identify prevention strategies Gain the support and expertise of PSOs to enhance quality and safety processes and practices Gain federal protections that fill the gaps left from peer review and attorney client privilege protections Meet the PPACA requirement PSO participation as a hedge against onerous state mandated reporting legislation 27

28 To Learn More AHRQ PSO Page Center for Patient Safety PSO Resources & Information

29 Services & Resources Available Contact Your PSO for Assistance Contact the Center for Patient Safety (CPS) PSO Services (Hospital, EMS, LTC, Culture Surveys) PSO Consultative Services & Resources PSO Participation Toolkit Policy Templates (PSES, PSWP, Confidentiality) Presentation Templates to educate leaders, workforce and committee and More Consultative and Education Service Options 29

30 Join us Again! Wednesday, October 16 at 1 PM CST PSO? PSES? PSWP? You Have Questions, We Have Answers More details on establishing a PSES Delving into PSWP Defining a PSES Workgroup and Workforce The Legal Landscape of PSO Protections 30

31 QUESTIONS??? Center for Patient Safety Contact our PSO Team Project Manager/Analyst: Alex Christgen Assistant Director: Carol Hafley, MHA, BSN, RN, FACHE Patient Safety Specialist: Eunice Halverson, MA Executive Director: Becky Miller, MHA, CPHQ, FACHE, CPPS Project Manager: Kathryn Wire, JD, MBA, CPHRM