Policy Recommendation for Patient Safety Legislations The PRO network was created by Congress to monitor and improve the quality of care delivered to Medicare beneficiaries in every state. PROs currently promote best practices across the country in the areas of heart attack, stroke, congestive heart failure, pneumonia, diabetes, mammography and many other local projects. PROs are already helping medical professionals perform quality improvement projects that address the root causes of medical errors. Their work prevents what could be labeled errors of "omission" (e.g. not prescribing drugs to prevent a second heart attack) as well as errors of "commission" (e.g. taking too long in starting "clot busting" therapy in a heart attack patient). AHQA supports an approach to improving patient safety that is built on the clinical quality improvement methods currently used by the national network of Medicare Peer Review Organizations (PROs). Expanding the PROs' responsibility to improve patient safety is a sensible way to address this problem for Medicare beneficiaries Ð and improving systems of care with Medicare participating providers improves care for all patients. The PRO approach complements, but does not require, a new reporting system. The PROs assist providers in targeting clinical areas of care that the scientific literature and medical community have already identified as areas in which care can be improved. The PROs help providers implement "best practices" that improve patient safety. AHQA does not oppose new reporting systems, but we believe that a patient safety bill that does not include this straightforward quality improvement approach is incomplete. The PRO approach is a voluntary opportunity for providers, not a mandate. Providers are not required to work with the PROs on quality improvement projects, but most hospitals already choose to work with their local PRO on one or more projects. New projects specifically focused on patient safety should enjoy the same degree of collaboration. The PRO approach is educational, not punitive. The PROs are not enforcement agencies. The sole purpose of PRO quality improvement projects is to help providers and practitioners identify where their systems of care can be improved and institute changes to bring about measurable improvement. New projects focused on patient safety would have the same goal. The PRO approach is confidential. Congress wrote into the PRO statute the strictest of confidentiality requirements. All information collected by the PROs for the purposes of their health care quality improvement work is non-discoverable (SSA Section 1160) -- even in court. AHQA Recommendation for Patient Safety Legislation The language below is based on a provision passed last year by the House Commerce Committee during the debate that resulted in BIPA 2000: IMPROVEMENT OF PATIENT SAFETY BY PEER REVIEW ORGANIZATIONS. (a) IN GENERAL.-Section 1154(a) (42 U.S.C. 1320c-3(a)) is amended by inserting after paragraph (11) the following new paragraph: ''The organization shall assist providers, practitioners, and Medicare+Choice organizations in quality improvement projects to reduce the incidence of medical errors and improve patient safety affecting individuals entitled to benefits under title XVIII. For the purposes of this part and title XVIII, the functions described in this paragraph shall be treated as a review function''.