IHA Daily Briefing: July 5

Thursday, July 5, 2018

Save the Date: Medicaid MCO Webinars: July 24-26
Learn More about MAPS PSO

Save the Date: Medicaid MCO Webinars: July 24-26
To address a significant member issue in the Medicaid Managed Care program, IHA engaged the Illinois Association of Medicaid Health Plans (IAMHP) to create a universal “provider roster.” The “provider roster” is the document submitted by providers to the Medicaid managed care organizations (MCOs) for use in their claims payment and directory system, for care coordination efforts and in a number of instances, to address the Centers for Medicare & Medicaid Services requirements.

In collaboration with IAMHP, IHA will be hosting the following joint training webinars to assist our members in understanding the new template:

  • Tuesday, July 24, 12 – 2 p.m.
  • Wednesday, July 25, 2 – 4 p.m.
  • Thursday, July 26, 8 – 10 a.m.

The sessions are designed for individuals who collect and submit provider information to MCOs, including medical staff personnel, credentialing verification organizations, and other employees who have responsibility for provider enrollment and credentialing. During the sessions, IHA and IAMHP staff will provide background on the tool; and MCO roster experts will provide a live demonstration of the new template and related instructions. The sessions will also include a question-and-answer session.

Registration information for these webinars will be available next week. IHA strongly encourages members to have their staff participate in one of the three training sessions.

Learn More about MAPS PSO
Federally-certified since 2010, Midwest Alliance for Patient Safety (MAPS) Patient Safety Organization (PSO) has assisted its members with the important work of reducing adverse events, helping them provide a safer healthcare experience for their patients. As a non-profit component of IHA, MAPS strives to position itself as the leading provider-sponsored PSO. Based in Naperville, MAPS provides the opportunity to exceed standards of quality of care by providing expert clinical staff, strong programs and services focused on federal protection and confidentialities, PSO education, strong patient-focused operations and performance improvement. Unlike the Illinois Medical Studies Act, the Patient Safety Quality Improvement Act of 2005 (PSQIA) also provides protections that span across all healthcare providers, allowing for collaborations and discussions that result in improved safety across facilities.

So why join a PSO? Patient safety organizations serve as independent and external resources that assist healthcare organizations in analyzing provided data. Adverse event reporting is voluntary but members who work with a PSO can benefit from the ability of PSOs to aggregate data from all of its members and analyze learnings from Patient Safety Work Product (PSWP). These learnings may include documents such as investigations, root cause analysis, mortality reviews and other patient safety activities. As a result, many PSOs develop large numbers of patient safety and near miss events essential for identifying the underlying causes of patient harm. The Patient Safety Act and Rule makes PSWP privileged and confidential. Subject to certain specific exceptions, PSWP may not be used in criminal, civil, administrative, or disciplinary proceedings.

Recently, Ingalls Memorial Hospital obtained a favorable appellate court ruling in a case that tested the strength of the federal law that protected Patient Safety Work Product. IHA wrote an amicus brief to support Ingalls' claims that certain information was not subject to discovery under the federal PSQIA because it had been compiled for submission to its PSO. Ingalls Memorial Hospital did not have to turn over documentation or PSWP because it was an active member of a PSO.

MAPS PSO members include 72 Midwestern health systems, hospitals, critical access hospitals, physicians groups, long-term care and specialty outpatient clinics.  MAPS focuses on improving patient safety across the continuum of care. Each benefit by utilizing the security of a protected PSO environment to collect, analyze and learn from adverse event data, and best practices. For more information on joining a PSO, contact Carrie Pinasco.