Patient Safety and Quality Improvement Act

Patient Safety and Quality Improvement Act of 2005

Long title	An act to amend title IX of the Public Health Service Act to provide for the improvement of patient safety and to reduce the incidence of events that adversely effect [sic] patient safety.
Acronyms (colloquial)	PSQIA
Enacted by	the 109th United States Congress
Effective	July 29, 2005
Citations
Public law	109-41
Codification
Acts amended	Public Health Service Act
Titles amended	IX
U.S.C. sections created	921–925
U.S.C. sections amended	921–928 (renumbered to follow the new 921–925)
Legislative history
Introduced in the Senate by Jim Jeffords on March 8, 2005 Committee consideration by Senate Health, Education, Labor, and Pensions; House Energy and Commerce Subcommittee on Health Passed the Senate on July 21, 2005 (Unanimous consent) Passed the House on July 27, 2005 (http://clerk.house.gov/evs/2005/roll434.xml 428–3) Signed into law by President George W. Bush on July 29, 2005

Health care in the United States
Government Health Programs
Federal Employees Health Benefits Program Indian Health Service Veterans Health Administration Military Health System / TRICARE Medicare Medicaid / State Health Insurance Assistance Program (SHIP) State Children's Health Insurance Program (CHIP) Program of All-Inclusive Care for the Elderly (PACE) Prescription Assistance (SPAP)
Private health coverage
Health insurance in the United States Consumer-driven health care Flexible spending account (FSA) Health Reimbursement Account Health savings account (HSA) High-deductible health plan (HDHP) Medical savings account (MSA) Private Fee-For-Service (PFFS) Managed care (CCP) Health maintenance organization (HMO) Preferred provider organization (PPO) Exclusive provider organization (EPO) Medical underwriting
Health care reform law
Emergency Medical Treatment and Active Labor Act (1986) Health Insurance Portability and Accountability Act (1996) Medicare Prescription Drug, Improvement, and Modernization Act (2003) Patient Safety and Quality Improvement Act (2005) Health Information Technology for Economic and Clinical Health Act (2009) Patient Protection and Affordable Care Act (2010)
State level reform
Massachusetts health care reform Oregon Health Plan Vermont health care reform SustiNet (Connecticut) Dirigo Health (Maine)
Municipal health coverage
Fair Share Health Care Act (Maryland) Healthy Howard (Howard Co., Maryland) Healthy San Francisco My Health LA Healthy Way LA

The Patient Safety and Quality Improvement Act of 2005^[1] (PSQIA): Pub.L. 109–41, 42 U.S.C. ch. 6A subch. VII part C, established a system of patient safety organizations and a national patient safety database. To encourage reporting and broad discussion of adverse events, near misses, and dangerous conditions, it also established privilege and confidentiality protections for Patient Safety Work Product (as defined in the act). The PSQIA was introduced by Sen. Jim Jeffords [I-VT]. It passed in the Senate July 21, 2005 by unanimous consent, and passed the House of Representatives on July 27, 2005 with 428 Ayes, 3 Nays, and 2 Present/Not Voting.^[2]

Lexology, in cooperation with the Association of Corporate Counsel, predicts that this law will be one of the top 10 health care law issues in 2010.^[3]

Context for the passage of the Act

The Notice of proposed rulemaking^[4] for this law describes the reason Congress passed it.

Much of the impetus for this legislation can be traced to the publication of the landmark report, "To Err is Human",^[5] by the Institute of Medicine in 1999 (Report). The Report cited studies that found that at least 44,000 people and potentially as many as 98,000 people die in U. S. hospitals each year as a result of preventable medical errors. Based on these studies and others, the Report estimated that the total national costs of preventable adverse events, including lost income, lost household productivity, permanent and temporary disability, and health care costs to be between $17 billion and $29 billion, of which health care costs represent one-half. One of the main conclusions was that the majority of medical errors do not result from individual recklessness or the actions of a particular group; rather, most errors are caused by faulty systems, processes, and conditions that lead people to make mistakes or fail to prevent adverse events. Thus, the Report recommended mistakes can best be prevented by designing the health care system at all levels to improve safety—making it harder to do something wrong and easier to do something right.

As compared to other high-risk industries, the health care system is behind in its attention to ensuring basic safety. The reasons for this lag are complex and varied. Providers are often reluctant to participate in quality review activities for fear of liability, professional sanctions, or injury to their reputations. Traditional state-based legal protections for such health care quality improvement activities, collectively known as peer review protections, are limited in scope: They do not exist in all States; typically they only apply to peer review in hospitals and do not cover other health care settings, and seldom enable health care systems to pool data or share experience between facilities. If peer review protected information is transmitted outside an individual hospital, the peer review privilege for that information is generally considered to be waived. This limits the potential for aggregation of a sufficient number of patient safety events to permit the identification of patterns that could suggest the underlying causes of risks and hazards that then can be used to improve patient safety.

Summary of the act's major sections^[1]

Definitions

Patient Safety Organization (PSO) must certify that it lists the requirements in the PSQIA and be listed on the Agency for Healthcare Research and Quality (AHRQ) web site.

The definition of Patient Safety Work Product (PSWP) is quite broad. Patient safety work product includes any data, reports, records, memoranda, analyses (such as root cause analyses), or written or oral statements (or copies of any of this material), which could improve patient safety, health care quality, or health care outcomes, that are assembled or developed by a provider for reporting to a PSO and are reported to a PSO. It also includes information that is documented as within a patient safety evaluation system that will be sent to a PSO and information developed by a PSO for the conduct of patient safety activities.

However, patient safety work product does not include a patient’s medical record, billing and discharge information, or any other original patient or provider information; nor does it include information that is collected, maintained, or developed separately, or exists separately, from a patient safety evaluation system.

Privilege and confidentiality protections

Patient Safety Work Product must not be disclosed, except in very specific circumstances and subject to very specific restrictions.

Note: the Patient Safety Activities Exception is the most common one that providers and PSOs will be working with.

Permitted Disclosures

• Patient Safety Activities — PSWP may be disclosed:
  • Between the Provider and the PSO — i.e.:
    • From the provider to the PSO, for Patient Safety Activities, and
    • From the PSO to the disclosing provider, for Patient Safety Activities
  • To a contractor of a Provider or a PSO
    • For contracted Patient Safety Activities
    • Contractor may not further disclose, except back to the contracted provider or PSO
  • Among affiliated providers, for Patient Safety Activities
    • From one PSO to another PSO or another provider, if
      • Direct identifiers (which are defined in the regulations) of any providers, affiliated organizations, corporate parents, subsidiaries, practice partners, employers, members of the workforce, or household members of such providers are removed; and
      • With respect to any Individually identifiable health information within the PSWP, a limited data set (also defined by regulation) is produced
• Business operations — A provider or PSO may disclose to attorneys, accountants or other professionals for business operations purposes.
  • Further disclosure (except back to the contracting entity) is prohibited
• Authorized by identified providers — Disclosure is permitted if all identified providers authorize the disclosure.
  • Authorization must be in writing, signed by the provider, and
  • Must state the nature and scope of the disclosure
• Accrediting bodies (e.g., The Joint Commission) — PSWP may be (but is not required to be) disclosed to an accrediting body if:
  • Any identified provider agrees to the disclosure; or
  • Direct identifiers of any provider (or affiliated organizations, corporate parents, subsidiaries, practice partners, employers, members of the workforce, or household members) are removed
• Nonidentifiable PSWP — May be disclosed
  • The regulations set out specific requirements for “nonidentification.”
• Research — This exception allows disclosure to researchers conducting certain types of research projects. If protected health information is involved, the HIPAA privacy and security rules also apply.
• Food and Drug Administration (FDA) — PSWP may be disclosed to the FDA
  • By a provider concerning an FDA-regulated product or activity,
  • By an entity required to report to the FDA about the quality, safety, or effectiveness of an FDA-regulated product or activity, or
  • By a contractor acting on behalf of the FDA or entity for these purposes
• Law enforcement — PSWP may be disclosed to law enforcement personnel
  • If the information relates to an event that either constitutes the commission of a crime, or for which the disclosing person reasonably believes constitutes the commission of a crime, provided that the disclosing person believes, reasonably under the circumstances, that the patient safety work product that is disclosed is necessary for criminal law enforcement purposes
• Criminal proceedings — But only after a court makes an in camera (in closed chambers) determination that:
  • The PSWP contains evidence of a criminal act;
  • The PSWP is material to the proceedings; and
  • The PSWP is not reasonably available from any other source
• Disclosure to permit equitable relief for reporting individuals — This exception allows use of PSWP by individuals who claim they have been the victim of an adverse employment action because the individual reported information to a PSO (either directly to the PSO or with the intent of having it reported to the PSO)
  • There must be a “protective order” issued by the court or administrative tribunal to protect the confidentiality of PSWP used in the proceeding

Violations & Enforcement

• An individual who knowingly or recklessly violates the confidentiality provisions is subject to a civil penalty of up to $10,000 for each act constituting such violation.
• Safe Harbor — a provider whose workforce member discloses PSWP is not deemed to have violated the Act if that workforce member disclosure does not include written or oral statements that:
  • Assess the quality of care of an identifiable provider, or
  • Describe or pertain to one or more actions or failures to act by an identifiable provider

Note: the individual workforce member of the provider would still be subject to possible penalties if the disclosure is knowing or reckless. This safe harbor does not apply to the PSO itself — i.e., a PSO workforce member’s disclosure is attributable to the PSO.

The Act is enforced by the Secretary of Health and Human Services

• PSWP may be disclosed to (and the Secretary may require disclosure of PSWP) to investigate or determine compliance with the Patient Safety Act or with HIPAA.

Patient Safety Organization certification and listing

Listed PSO logo: only officially listed PSOs may display this logo.

See also

• Medical error
• Patient safety
• Patient safety organization
• Safety engineering

References

1. Patient Safety and Quality Improvement Act
2. S. 544 (109th) — Patient Safety and Quality Improvement Act of 2005 (GovTrack.us)
3. Top 10 health law issues for 2010
4. Patient Safety and Quality Improvement — Proposed Rule, Federal Register February 12, 2008, pages 8112–8183.
5. Kohn, Linda T.; Corrigan, Janet M.; Donaldson, Molla S., eds. (2000). To Err is Human—Building a Safer Health System. Washington, D. C.: National Academies Press. p. 312. ISBN 978-0-309-06837-6.

Further reading

• Mattie, A.; Ben-Chitrit, R. (2007). "Patient safety legislation: a look at health policy development". Policy, politics & nursing practice 8 (4): 251–261. doi:10.1177/1527154407313467. PMID 18337431.
• White paper describing interaction of PSQIA and California laws
• Clancy, C. M. (2008). "New patient safety organizations lower roadblocks to medical error reporting". American Journal of Medical Quality 23 (4): 318–321. doi:10.1177/1062860608319673. PMID 18658105.
• Patient Safety Act: HHS Is in the Process of Implementing the Act, So Its Effectiveness Cannot Yet Be Evaluated (PDF) (Report). United States Government Accountability Office. 2010. Retrieved 2/12/2010. Check date values in: |access-date= (help)
• Vemula, R; Robyn Assaf, R; Al-Assaf, AF (2007). "Making the Patient Safety and Quality Improvement Act of 2005 work". Journal for healthcare quality : official publication of the National Association for Healthcare Quality 29 (4): 6–10. PMID 17849674.

External links

• AHRQ FAQ for the Patient Safety and Quality Improvement Act
• Listed Patient Safety Organizations
• PSO Common Formats