AHRQ Guidance: PSOs, Parent Organizations and Affiliated Providers

August 2, 2016    |   By: Kathy Wire, JD, MBA, CPHRM, CPPS

The Patient Safety and Quality Improvement Act (PSQIA) and its associated regulation allow affiliated providers to share protected PSWP.  Providers are “affiliated” if they either have a parent/subsidiary relationship or are common subsidiaries of a single parent.  The regulation outlines the requirements for those categories, but generally the parent must have control over the subsidiary/affiliated organization.  (We recognize that many non-profit organizations use a term other than “subsidiary,” but we will use it here to generally represent the non-parent.)

AHRQ published a new guidance document in June 2016 which discusses these issues in further detail and also outlines some situations in which potentially related organizations would not qualify as “affiliated.”  The Guidance stresses that the meaning of “parent organization” may be broader than it is in corporate law, and that it depends on “actual organizational control, rather than the organizational structure.”   AHRQ defines “control” as “the authority to control of manage agenda setting, project management, or day-to-day operations” of the subsidiary entity.  AHRQ stated that it intends to retain a great deal of flexibility in this interpretation.  Ownership of enough stock to control the subsidiary also qualifies; the ownership need not be a majority to create control.  A PDF of the new Guidance is available at:  https://pso.ahrq.gov/legislation/assessment.

The Agency is less forgiving in reviewing multi-level arrangements, where a high-level parent sits over a system, which sits over individual provider entities.  The ability to control must reach from the top to the bottom for all these organizations to be affiliated providers.

Items for consideration:

  1. PSO participants relying on the “affiliated provider” provision should review the new Guidance.
  2. Be careful to review other documents and pleadings to make sure that the participant is not making statements denying control in the context of, for example, efforts to establish parent-organization liability in a malpractice case.
  3. Multi-level organizations need to review the Guidance and make sure their PSWP workflow is in compliance. Remember, representatives of a non-affiliated parent can still be part of a facility workforce, so long as they meet the requirements.  And aggregated data can flow to the non-affiliated parent.
  4. A PSO that resides at the upper level of an organization will not be affected by this Guidance, but it will be constrained to follow all PSWP requirements that apply to PSO’s.


The statute and regulation are available at https://pso.ahrq.gov/LEGISLATION.  Participants in the Center for Patient Safety PSO may contact the Center at any time with questions.


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