The Third-Leading Cause Of Death Is Preventable, But Candidates Don’t Mention It
It is more likely to kill you than terrorism. It has profoundly impacted virtually every American family. So this election year, why aren’t politicians at all levels of government talking about the third-leading cause of death in America—preventable errors in healthcare?
The statistics are staggering: More than 500 patients per day are killed by errors, accidents and infections in hospitals alone. Medical errors kill more people annually than breast cancer, AIDS or drug overdoses. One in four Medicare beneficiaries admitted to a hospital suffers some form of preventable harm during their stay. And yet, it’s nowhere to be found in those stump speeches.
There are a few reasons for the silence. First is all about the illogical way Americans pay for healthcare. With the traditional “fee for service” model, we pay for procedures and tests—not outcomes. It means we also pay for medical mistakes. If you got the wrong medication in post-op, chances are no doctor or nurse will tell you about it. But it will show up on your bill, alongside the charges for any other intervention required to treat your adverse reaction. Considering that deciphering these bills is akin to reading hieroglyphics, many of us are victims of medical mistakes without even realizing it.
Another reason we may not hear much about it is that our political candidates are not eager to annoy deep-pocketed supporters. Last year, the healthcare and pharmaceutical sector was the top lobbying industry in Washington, spending $240 million—twice as much as Big Oil. At the local level, hospitals are often one of the largest employers in a community, a pillar of almost every congressional district. While many healthcare leaders are outspoken and bold proponents of change, some are embarrassed by the errors and would prefer their politicians not dwell on them.
Just this summer, CMS faced enormous backlash after announcing its intention to issue five-star ratings for hospital safety and quality, based on over 60 tested and validated measures. (My organization also assigns grades to hospitals based on data from CMS and our own annual hospital survey.) Congress tried to suppress the release of the CMS star ratings, at the urging of the hospital lobby, which argued the measures weren’t perfect and the methodology wasn’t fair. (Fortunately, it didn’t prevail and the ratings were released, albeit a few months behind schedule.)
Finally, how to measure healthcare performance—what data to collect and how to share it—can be as controversial as the current election itself. Most healthcare leaders agree we need to measure quality to ensure accountability and improvement, but the agreement stops there. Many leading researchers and organizations like the National Quality Forum, which reviews and validates quality metrics, have helped guide us toward resolving some of these controversies, but the debate rages on.
Curiously, experts even disagree over how to measure the death toll from medical errors. Earlier this year the reputable
BMJ released a study showing that medical errors are the third-leading cause of death in the U.S. But some researchers pushed back, citing concerns about the study’s definition of medical error. This led to a distracting and disheartening series of arguments in the medical literature about which errors outright kill patients and which merely hasten a patient’s inevitable decline. Can’t we agree that even one preventable patient death is one too many? And everyone agrees that at a minimum the death toll is in the thousands.
The good news that candidates should embrace is that this problem can be solved, and it’s not expensive to do so. The ad-
ministrations of Presidents Bush and Obama made substantial moves to shift Medicare away from the bloated fee-for-service model. Many employers and other purchasers of health benefits have taken similarly bold steps. A good number of hospitals and health systems have dramatically improved their safety records by making patient well-being a top priority. That means they enforce rules about hand hygiene or surgical checklists, and follow known best practices for protecting their patients. As a result of this progress, deaths and injuries from infections and errors are down, particularly in high-performing health systems. But too many Americans remain at serious risk.
Solving this requires putting a priority on patients. Elected officials, health systems and business leaders showed us results by embracing that priority. Now it’s time for our candidates to do the same.