Medical mistakes happen every day, causing harm to patients in various healthcare facilities. Even with thorough monitoring and quality initiatives in place, preventable injuries continue to be a major issue. To tackle this, the Centers for Medicare & Medicaid Services (CMS) launched the Patient Safety Structural Measure (PSSM) in August 2024. This program addresses the fundamental structural and cultural reasons behind harm instead of solely concentrating on past quality enhancements.
In consultancy engagements, many hospital leaders, such as CFOs, CMOs, COOs, and CEOs, lack full awareness of the updated CMS PSSM mandates for the ongoing calendar year. They often underestimate the effort needed to adopt the required strategies and practices, failing to comprehend the potential consequences on future Medicare reimbursements if they fall short of compliance.
**PSSM: What is it, and why is it significant?**
PSSM is intended to motivate hospital leaders to invest in safety culture and systems through improved reporting and public transparency. The regulatory structure ties reimbursements to a hospital’s structural dedication to patient safety, shifting the focus from basic clinical outcomes to a proactive strategy. PSSM evaluates hospitals based on 25 structural quality and safety factors, each comprising five criteria. Leaders typically remain unaware of the specifics of this scoring system, leading to partial compliance. Without a complete framework and procedures established, hospitals frequently receive low scores in preliminary evaluations.
Some actionable elements, such as allocating 20% of governing board meeting agendas to safety reports or performing annual culture of safety surveys, are clear-cut but often not prioritized. As the year moves forward, hospitals need to accelerate their plans to attain a complete score.
**What’s at risk: reimbursement and reputation**
Hospitals face diminished Medicare reimbursements for FY 2027 if PSSM data is not submitted for CY 2025. With escalating expenses and decreasing reimbursement rates, further cuts threaten hospital profitability. After an initial year concentrating on timely reporting, future years will tie reimbursement to PSSM results, further influencing payments based on scores ranging from 0 to 5.
Moreover, starting in 2026, PSSM scores will be publicly displayed on the Care Compare platform. Adverse scores could harm a hospital’s reputation, affecting patient choices, particularly in competitive areas. This reputational damage could translate into lower patient numbers and diminished revenue.
**A guide for hospital leaders: operational and cultural transformation**
PSSM aims to assist hospital leaders in managing risks, identifying inefficiencies, and cultivating a culture that prevents patient harm. Strong governance is pivotal, with a C-suite executive overseeing the comprehensive patient safety strategy. By integrating safety into operations, ensuring transparency, and aligning leadership with board priorities, hospitals can achieve notable safety improvements.
Board members should receive regular updates on safety data, allocate resources that align with zero-harm objectives, and embed safety into strategic planning. Compliance starts with a comprehensive evaluation against the 25 required elements, backed by project plans to fill gaps and assign accountability.
An often-neglected component is expanding safety training to encompass all personnel, not just clinical staff. Since non-clinical employees frequently first engage with patients and can identify risks, extensive training for all staff is vital for nurturing a true safety culture.
A robust safety culture interlinks quality and safety initiatives with tangible impacts on individuals. Leaders should regard safety as a fundamental organizational value, reducing negative incidents. A strong safety culture can lower costs, reduce redundancies, optimize resource use, improve staff retention, and position hospitals favorably in value-based models.
Adopting a cohesive approach allows leadership to perceive safety as both a moral obligation and a strategic advantage, steering compliance, operational excellence, cultural evolution, and long-term viability.
Is your hospital prepared?
*Kim Adelman is a health care executive.*