COVER STORY

Modern Healthcare - - EDITORIAL MODERN HEALTHCARE -

As the CMS pushes for ac­count­able care or­ga­ni­za­tions, a num­ber of states are adding Aco-like fea­tures to their Med­i­caid pro­grams. Many see those changes as likely to boost qual­ity while sav­ing money. “The abil­ity to appropriately man­age and pro­vide the ser­vices that those low-in­come pa­tients need in a way that is cost-ef­fec­tive is the most im­por­tant way to main­tain ac­cess to care for all,” says Kate Walsh, left, of Bos­ton Med­i­cal Cen­ter.

The vast ma­jor­ity of in-hos­pi­tal ad­verse events go un­re­ported by staff, ac­cord­ing to a re­port from HHS’ in­spec­tor gen­eral’s of­fice. Us­ing a month of sur­vey data from a sam­ple of 189 hos­pi­tals, the in­spec­tor gen­eral’s of­fice found that hos­pi­tals’ vol­un­tary in­ci­dent reporting sys­tems cap­tured only about 14% of events that cause pa­tient harm, such as med­i­ca­tion er­rors. Fed­eral in­ves­ti­ga­tors at­trib­uted low reporting rates, at least in part, to poor knowl­edge among hos­pi­tal staff about what pa­tient harm ac­tu­ally means. “For ex­am­ple, staff re­ported only one of 17 sam­ple events re­lated to catheter us­age (e.g., in­fec­tion and uri­nary re­ten­tion), a com­mon cause of harm to Medi­care ben­e­fi­cia­ries,” ac­cord­ing to the re­port. Other types of events that went un­re­ported in­cluded cases of ex­ces­sive bleed­ing re­lated to mis­use of blood thin­ning med­i­ca­tions and hos­pi­tal-ac­quired in­fec­tions. In­ci­dent reporting sys­tems are a re­quire­ment for par­tic­i­pa­tion in Medi­care, but a lack of uni­form re­quire­ments—such as lists staff can use to iden­tify pa­tient harms— can dam­age the sys­tems’ re­li­a­bil­ity, ac­cord­ing to the re­port. “Be­cause hos­pi­tals rely on in­ci­dent reporting sys­tems to track and an­a­lyze events, im­prov­ing the use­ful­ness of these sys­tems is crit­i­cal to hos­pi­tals’ ef­forts to im­prove pa­tient safety,” ac­cord­ing to the re­port. The re­port urged the CMS and HHS’ Agency for Health­care Re­search and Qual­ity to de­velop a list of ad­verse events for hos­pi­tals to use. The CMS, the re­port stated, should re­assess its meth­ods for judg­ing hos­pi­tal com­pli­ance with the reporting-sys­tem re­quire­ment.

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