Medicare hospital patients face 25% chance of adverse event
■ Physicians who reviewed a report by the Office of Inspector General find that 44% of the adverse events were preventable.
By Katie Merx Sarver, amednews correspondent — Posted Dec. 6, 2010
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More than one in four Medicare patients experienced an adverse or harmful event when hospitalized, according to a November report that urges broadening government programs to improve safety.
About 13.5% of hospitalized Medicare beneficiaries experienced adverse events during their hospital stays in October 2008, the Dept. of Health and Human Services' Office of Inspector General reported. Another 13.5% of Medicare patients experienced events that caused temporary harm. And an estimated 1.5% -- or 180,000 patients a year -- experienced an event that led to their deaths. The study sampled 780 Medicare patient experiences.
"This is a rate of harm you would expect from combat," said Leah Binder, CEO of the Leapfrog Group, a Washington, D.C.-based organization representing health care purchasers that works to improve the quality, safety and affordability of health care. "Basically, one in every four Medicare patients is suffering harm in the hospital. None of us would get on a plane if there were a one-in-four chance of harm. This is a crisis."
Physicians who reviewed the results for the OIG concluded that 44% of the adverse events were preventable -- for example, wrong medication being administered -- and 51% were not preventable.
These percentages of harm are higher than what earlier studies found.
In response to the findings, the OIG recommends broadening the definition of adverse events; creating clear goals for improvement; and establishing incentives for improvement and disincentives for errors, such as Medicare payment penalties and prohibiting Medicaid payments for care associated with hospital-acquired conditions.
"We are committed to taking additional needed steps to improve patient care," the American Hospital Assn. said in a statement. "That is why we support the report's recommendations for further research to improve our understanding of what caused the error and how to prevent it from happening again."
Hospital care associated with adverse and temporary-harm events cost Medicare an estimated $324 million in October 2008, the study showed. In fiscal 2009, that would have equaled $4.4 billion of the $137 billion paid in Medicare inpatient expenditures, the report said.
The Agency for Healthcare Research and Quality said it has sponsored efforts to address specific types of adverse events -- such as central-line-associated bloodstream infections and venous thromboembolisms -- and supported efforts to address underlying causes that contribute to a wide variety of adverse events, AHRQ Director Carolyn M. Clancy, MD, wrote in comments attached to the OIG report.
Donald M. Berwick, MD, administrator of the Centers for Medicare & Medicaid Services, said in comments concerning the OIG's report that "solutions need to be addressed as quickly and efficiently as possible" and that CMS has taken significant steps in that direction.
CMS is launching several efforts to create incentives for hospitals to identify adverse events, establish practices to prevent them and significantly decrease the rates of adverse events in hospitals, Dr. Berwick wrote. Among the expanded programs is a plan to reduce payments when established targets for reducing adverse events are not met.
William Conway, MD, senior vice president and chief quality officer for the Henry Ford Health System in Detroit, said safety continues to be a serious problem for all hospitals. His health system recently concluded a three-year program to reduce errors that resulted in a 25% decrease in adverse events across the six-hospital system.
"Hospitals are getting better at a rate of about 2% a year," Dr. Conway said. "It is improving, but, as this study shows, it's not improving fast enough."