Patient Safety Learning welcomes new US hospital patient safety measure (8 August 2024)

Summary

The Centers for Medicare and Medicaid Services (CMS) this month have confirmed they will add seven new measures to their hospital inpatient quality reporting programme starting from 2025. In this short blog, Patient Safety Learning comments on the inclusion of a new Patient Safety Structural Measure (PSSM) as part of this.

Content

The CMS is a federal agency within the United States Department of Health and Human Services. It pays acute care hospitals and long-term care hospitals under two systems, the Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The law requires the CMS to update payment rates annually and as part of this it also sets quality measures and efficiency measures for hospitals in the United States of America.

This month the CMS has confirmed it will adopt seven new quality measures for the fiscal year 2025.[1] One of these new measures is the Patient Safety Structural Measure (PSSM), which will begin at the start of 2025.

Patient Safety Structural Measure

This is an attestation-based measure that assesses whether hospitals demonstrate having a structure and culture that prioritises patient safety. It is informed by Safer Together: The National Action Plan to Advance Patient Safety as well as scientific evidence from existing patient safety literature, and detailed input from patient safety experts, advocates, and patients.[2]

The Patient Safety Structural Measure includes five domains, each containing multiple statements that aim to capture the most salient structural and cultural elements of patient safety:

1. Leadership commitment to eliminating preventable harm
2. Strategic planning and organizational policy
3. Culture of safety and learning health system
4. Accountability and transparency
5. Patient and family engagement

Hospitals will attest to whether they engage in specific evidence-based best practices within each of these domains to achieve a score from zero to five out of five points.[3] You can find a detailed breakdown of the five domains here.

Patient Safety Learning perspective

At Patient Safety Learning we welcome the CMS’s decision to adopt this new Patient Safety Structural Measure. We believe that this attestation-based model aligns with our organisational view that it is essential that we apply standards of good practice for patient safety in the way that we do for other safety issues.

In December last year we set out our strong support for this proposal in our response to the public consultation on this.[4] The approach in the Patient Safety Structural Measure has a similar basis to our Patient Safety Standards, enabling organisations to self-assess their current patient safety performance, identifying both strengths and weaknesses.[5] The outputs can form the basis for a comprehensive patient safety strategy, as well as the foundations for evidence-based improvement programmes.

Likewise, organisations are assessed in our Patient Safety Standards against each of the seven foundations, which significantly align and overlap with the five domains set out in the Patient Safety Structural Measure. In our consultation feedback, we set out in more detail our views on each of the five domains included in the Measure. 

References

1. Centers for Medicare and Medicaid Services, FY2025 Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital Prospective Payment System (LTCH PPS) Final Rule – CMS-1808-F, 1 August 2024.
2. Institute for Healthcare Improvement, Safer together: A national action plan to advance patient safety, 14 September 2020.
3. Centers for Medicare and Medicaid Services, Rules - Medicare, Medicaid, and Children's Health Insurance Programs: Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates, etc, 1 August 2024.
4. Patient Safety Learning, Feedback on the CMS list of Measures Under Consideration: Patient Safety Structure Measure (#MUC2023-188), 21 December 2023.
5. Patient Safety Learning, Why Standards?, 8 August 2024.