Hospitals, MedCity Influencers, Policy

Ending unnecessary medical errors means major political, hospital reforms

Unnecessary medical errors are at an astounding level. One of every seven Medicare hospital patients are injured and 15,000 are killed each month by bad medical practices. How would that error rate fly in the airline industry? Solving the problem will require hospital reorganization and payment reform. But Washington is in a position to make sure that doesn't happen anytime soon.

The latest Washington Monthly carries an important story documenting the high cost of unnecessary medical errors. Here’s the toll:

In November 2010, the U.S. Department of Health and Human Services issued a study that covered just the 15 percent of the U.S. population enrolled in Medicare. It found that each month one out of seven Medicare hospital patients is injured—and an estimated 15,000 are killed—by harmful medical practice. Treating the consequences of medical errors cost Medicare a full $324 million in October 2008 alone, or 3.5 percent of all Medicare expenditures for inpatient care.

Those who follow health care closely have long been aware of this problem, which would never be tolerated in, say, the airline industry. The Institute of Medicine in its landmark study “To Err Is Human” in the late 1990s estimated there were nearly 100,000 deaths a year from unforced medical errors, the equivalent of a jumbo jet liner crashing and killing everyone aboard every day.

The latest Health Affairs, released this week, is devoted to innovation in medicine. A number of hospitals across the country have dramatically lowered their error rates by adopting checklists for eliminating hospital-acquired infections and the equivalent of the Toyota manufacturing system for making steady improvements in hospital procedures that can end procedural and medication errors.  I attended the event long enough to hear Christopher Langston, the program director of the John A. Hartford Foundation, decry the fact that once a person enters the medical system, they have a staggering 19 percent chance of experiencing a “preventable negative event.”

The Washington Monthly article suggested better disclosure of error rates would begin to solve the problem. It will help. Shame can be a powerful motivating factor to spur on change.

But Langston, whose foundation has funded many of the best-case examples presented at the Health Affairs session, said far more was called for. Change, he said, “was profoundly counter-cultural” at most medical institutions, since it involves getting health care professionals to work in teams and pushing responsibility for routine patient and follow-up care down the hierarchical ladder to nurses, physician assistants and other para-professionals. It also is costly for hospitals, since patients and payers “expect a very big discount if they’re not going to be seeing their doctors.”

Transparency is a start. But solving the problem will require hospital reorganization and payment reform. If you want to know how far the nation is from that, pay attention to the fact that 42 Senators just signed a letter calling for the removal of Donald Berwick as head of the Centers for Medicare and Medicaid Services. He’s probably the best-qualified person in America to lead the health care system toward the changes needed to raise the quality of care and eliminate unnecessary errors. Alas, in today’s Washington, the Republicans calling the shots seem hellbent on sending anyone with skills and  competence off to the countryside to labor with the peasants, sort of like Mao Tse-Tung during China’s cultural revolution. We’re likely to get similar results.

The author, Merrill Goozner, is an award-winning journalist and author of “The $800 Million Pill: The Truth Behind the Cost of New Drugs” who writes regularly at Gooznews.com.


Merrill Goozner

Merrill Goozner is an award-winning journalist and author of "The $800 Million Pill: The Truth Behind the Cost of New Drugs" who writes regularly at Gooznews.com.

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