New draft standards for patient safety have been issued by URAC, formerly
known as the Utilization Review Accreditation Committee.
The voluntary standards are designed to provide a framework for
organizations conducting medical-management activities to develop strategies
to improve patient safety. They are not intended to be part of the "core
standards" by which URAC accredits case management, utilization
management, and other related organizations.
But psychiatrists involved in the effort to improve patient safety hope
they will become part of those standards.
"The standards are a good first step toward moving the organizations
that URAC accredits toward patient safety consciousness," said Al
Herzog, M.D., chair of APA's Committee on Patient Safety. "What I would
like to see is for these to become policy directives, so that when these
organizations are accredited they are really being held to patient safety
Albert Vogel, M.D., an APA representative to the URAC Committee on
Standards and APA's Area 7 trustee, agreed in his assessment of the standards."
They are potentially useful as informational standards," he told
Psychiatric News. "They contain good ideas, and my sense is
that they are more likely to be useful than problematic."
URAC accredits health plans, PPOs, case management and utilization
management organizations, and health Web sites, among other entities. As a
member organization, APA has representatives on the URAC Board of Directors,
Standards Committee, and Accreditation Committee.
The URAC standards are part of a wide-ranging effort throughout medicine to
reduce errors and adverse events, emphasizing a "systems" approach
to replace the standard system of citing individual fault and liability.
That effort was instigated largely by the 1999 Institute of Medicine
report, "To Err Is Human: Building a Safer Health System." The
release of the report prompted all sectors of the health care system to play a
stepped-up role in reducing medical errors and adverse events that result in
potential or actual harm to patients. Medical-management programs, of the kind
accredited by URAC, were particularly singled out in the IOM report.
"Medical management organizations have the potential to promote a
safer health care system," said Robert Crocker, M.D., senior vice
president and national medical director of WellPoint Health Networks, chair of
the URAC Patient Safety Advisory Committee, and vice chair of the URAC Board
"URAC has taken a leadership role in developing these informational
patient safety standards, created with the intent to actively contribute to a
culture of patient safety across the entire health care continuum."
The new standards cover systems for safety, training and education,
tracking and reporting processes, quality improvement, and collaboration.
Vogel and Herzog agreed that as the standards become incorporated into the
accrediting process, there is liable to be "push back" from
organizations concerned about those standards that are likely to require an
outlay of money. "For many of the organizations URAC accredits, quality
is secondary to cost," Herzog said. "But it comes down to how much
value you put on patient safety. All of us need to provide safe care. That has
to be the prevailing value."
In the meantime, URAC officials are stressing the voluntary nature of the
"We hope that medical management programs will voluntarily use these
informational standards in the evaluation of their operations in order to
determine where they can implement changes to promote safety," said
Annette Watson, R.N., a URAC vice president. "However, like many health
care organizations, medical-management programs are just beginning to
recognize their role in promoting patient safety and may take several years to
fully gear up and develop systems needed to do so.
"URAC is not planning a full-scale patient safety accreditation
program at this time," Watson added, "but will continue to
advocate for a national patient safety agenda that includes the appropriate
involvement of medical management that contributes to a culture of safety
throughout the entire delivery system." ▪