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Managing Risk and Patient Safety Across an ACO


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Managing Risk and Patient Safety Across an ACO

By Luke Sato, MD, CRICO, Ann Louise Puopolo, BSN, RN, CRICO, and Sue Cornacchio RN, JD, CRICO

Related to: Patient Safety Awareness, Teamwork Training

Hazard Identification and Event Management across ACOs 

Accountable Care Organizations (ACOs) will be made up by provider groups in multiple locations across different geographic locations.  A key benefit would be a way to systematically identify hazards or emerging risks that could create harm across this clinical environment.  An online safety event reporting system would support analysis as well as timely notification and escalation of significant events across the ACO.  Providers would be able to quickly respond to events and intervene to provide support to patients and staff.  Event reporting data would enable front line managers to see where changes needed to be made and could empower them to make any needed adjustments.  An open and transparent process of event detection and response would be a key component of a culture of safety and excellence.  Review of critical event management can also be a powerful tool to ensure ongoing engagement at the ACO leadership level.


The Patient Safety and Quality Improvement Act of 2005 allows providers to contract with Patient Safety Organizations (PSOs) and voluntarily report information on a federally peer review protected and confidential basis.  Information, including patient safety event reports and root cause analyses can be submitted to the PSO and protected in the event of a malpractice suit or claim.  

Through a component entity, CRICO has created its federally listed Academic Medical Center Patient Safety Organization (AMC PSO).  ACOs could decide to use the AMC PSO as a forum for discussion and analysis of key safety issues and identification of best practices that will improve safety and quality of patient care. ACOs would also have the opportunity to work collaboratively with other AMC PSO member organizations and gain exposure to insights from members outside of their particular healthcare delivery system.  

In 2015, CMS regulations will require health plans participating in state-based health exchanges to contract only with hospitals (over 50 beds) that are participating in a PSO. This requirement is expected to accelerate the demand for well designed and effective PSOs in the next few years. 

Captive malpractice insurance company can meet this need

It is too soon to know if ACOs will increase or decrease medical malpractice exposure.  But, healthcare captive insurance companies, such as CRICO, are ideally suited to meet the needs of the various types of providers and entities that comprise an ACO.  The captive can use this opportunity to continue to systematically support the development and implementation of activities to decrease patient harm and mitigate costs.  It can also leverage its safety and risk management services to support a culture of excellence and improvement.  Captive insurance companies can drive initiatives by using carefully designed preĀ­mium incentives and risk-management grants that promote patient safety and risk reduction efforts. They are also well suited for the successful management of cases with multiple defendants.

Related Links

CRICO’s AMC PSO home page

October 19, 2012
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