QUAL­ITY:

13.5% of Medi­care pa­tients harmed dur­ing hos­pi­tal stays, study says

Modern Healthcare - - Front Page - Gregg Blesch

Anew look at how many Medi­care pa­tients are in­jured and killed by their care in hos­pi­tals has armed the CMS with cause to be­come more deeply in­volved in ef­forts to im­prove qual­ity and safety.

One in seven Medi­care pa­tients hos­pi­tal­ized suf­fered an ad­verse event, broadly de­fined as harm to pa­tient caused by med­i­cal care, ac­cord- ing to an anal­y­sis by HHS’ in­spec­tor gen­eral’s of­fice of a ran­dom sam­ple of 780 Medi­care ben­e­fi­cia­ries hos­pi­tal­ized in Oc­to­ber 2008. The por­tion of those pa­tients who suf­fered ad­verse events ex­trap­o­lates out to about 134,000 pa­tients in that sin­gle month and 1.6 mil­lion over a full year.

An equal num­ber suf­fered less se­ri­ous harm that re­quired med­i­cal in­ter­ven­tion (in­clud­ing some pa­tients who ex­pe­ri­enced both types), and Medi­care likely paid $4.4 bil­lion, 3.5% of its in­pa­tient bud­get, to pay for the treat­ment con­nected to the events. The re­sults in­di­cate that ad­verse events “con­trib­uted” to about 180,000 deaths that year.

The in­spec­tor gen­eral’s of­fice pulled med­i­cal records for the pa­tients and com­mis­sioned physi­cians to re­view them to de­ter­mine whether they suf­fered ad­verse events and whether those events were on the Na­tional Qual­ity Fo­rum’s list of “se­ri­ous re­portable events” or Medi­care’s list of hos­pi­tal-ac­quired con­di­tions.

CMS Ad­min­is­tra­tor Don­ald Ber­wick and Carolyn Clancy, di­rec­tor of HHS’ Agency for Health­care Re­search and Qual­ity, re­sponded to In­spec­tor Gen­eral Daniel Levin­son that they sup­ported the rec­om­men­da­tion in the re­port, the first of which is that they broaden pa­tient safety ef­forts to re­flect the wider uni­verse of events cap­tured in the re­port.

Few of them—about 1%—are cap­tured by Medi­care’s ef­forts to iden­tify con­di­tions ac­quired dur­ing hos­pi­tal stays and to stop pay­ing hos­pi­tals more for treat­ing things they caused or failed to pre­vent.

Also, only 0.6% of the ad­verse events were ones that would have been on the Na­tional Qual­ity Fo­rum’s list of se­ri­ous re­portable events. Even many of the gravest in­ci­dents dis­cov­ered in the sam­ple were not rep­re­sented on the NQF list, which fo­cuses on a spe­cific set of events. Of 18 in­ci­dents in the sam­ple that caused se­ri­ous dis­abil­ity or death, only two were on the list, ac­cord­ing to the re­port.

“This re­port sug­gests you’d have to be a dare­devil to al­low your­self to be ad­mit­ted to a hos­pi­tal,” said Leah Bin­der, CEO of the Leapfrog Group. “What other in­dus­try in hu­man his­tory has a rate of in­jury like that? Maybe tightrope walk­ers or peo­ple who get shot out of can­nons.”

Ber­wick re­sponded to the find­ings and rec­om­men­da­tions in a 10-page let­ter. Ber­wick said the agency in­tends to at­tack the prob­lem, us­ing such things as the cri­te­ria for mean­ing­ful use of health in­for­ma­tion tech­nol­ogy and the fi­nan­cial in­cen­tives of val­ue­based pur­chas­ing.

Nancy Foster, the Amer­i­can Hos­pi­tal As­so­ci­a­tion’s vice pres­i­dent for qual­ity and pa­tient safety, cau­tioned that the method­ol­ogy may lead the pub­lic to think the num­bers re­flect only pre­ventable med­i­cal er­rors.

NQF Pres­i­dent and CEO Janet Cor­ri­gan noted that the list of se­ri­ous re­portable events has grown broader since the year the in­spec­tor gen­eral’s of­fice drew its sam­ple.

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