Measuring Patient Safety & Quality

Although the upcoming CMS rules for inpatient and outpatient care eliminate references to health equity and social determinants of health, two CMS measures will continue to encourage healthcare organizations to address these issues: the patient safety structural measure and the age-friendly care measure. (Even the proposed OPPS rule refers to upstream drivers of health. The vocabulary may have changed, but the challenge has not.)

As Dr. Kedar Mate often emphasized during his time at the Institute of Healthcare Improvement, "There is no quality without equity."

The Patient Safety Structural Measure is a new safety measure that assesses how well hospitals have implemented practices and methods to strengthen systems for safety and a culture of safety. Reporting begins in calendar year 2025, with payment determination in FY 2027. Hospitals will be penalized (in the form of a reduction in their Annual Percentage Update) if they do not report on the measure.

Similar to the health equity measure that was previously discontinued, there are five domains. Hospitals must attest to reaching every statement in each domain, with one point awarded for each. Beginning in the fall of 2026, CMS will publish the scores in the Care Compare section on Medicare.gov.

The five domains are:

• Leadership commitment to eliminating preventable harm

• Strategic planning and organizational policy

• Culture of safety and learning health system

• Accountability and transparency

• Patient and family engagement

The measure contains many of the components of the previous health equity measure, including leadership commitment, the ability to stratify data to identify disparities in care, data dashboards to track improvement, and promoting patient and family engagement. It recommends ensuring diverse representation on the hospital's Patient and Family Advisory Council and integrating community input into safety-related activities.

Similarly, the CMS Age-Friendly Hospital Measure will focus on leadership commitment, whole-person care, assessing social vulnerability, and improving outcomes and patient experience. (It's what matters!) The first mandatory reporting period is January 1-December 31, 2025, with attestation due by May 15, 2026.

These may be new measures, but they should sound very familiar to those who spent the last few years focusing on improving health outcomes in their communities. The work continues. The measures are an opportunity to move your quality improvement work upstream, focusing not only on disparities in outcomes but on structures and system processes, too.

Further Resources:

• AHRQ's Toolkit on the Patient Safety Structural Measure

• AHRQ's Communication and Optimal Resolution (CANDOR) Toolkit

• IHI's Safer Together: A National Action Plan to Advance Patient Safety

• CMS Age-Friendly Measure: Overview for Hospitals and Health Systems