A handful of state governments are doing cutting-edge work on medical errors and quality accountability that the other states and the federal government would do well to emulate. So said HHS' inspector general's office in a report issued last week.
The report comes as Congress hears testimony and considers plans to improve the care provided by hospitals and physicians. A key issue in the debate, ignited by the November release of the Institute of Medicine's report on patient deaths, is whether the reporting of medical errors should be voluntary or mandatory.
The inspector general's report on state initiatives is a follow-up to the four-part series on hospital oversight that the agency wrote last year. In those reports, the agency charged with enforcing Medicare and Medicaid regulations took issue with how effectively HCFA and the Joint Commission on Accreditation of Healthcare Organizations ensure quality of care in the nation's hospitals.
The good guys in the inspector general's latest report are Colorado, New Jersey, New York, Pennsylvania and Utah. Each has created a unique method of looking over hospitals' shoulders:
* Colorado posts hospitals' compliance history and serious events reports on a state World Wide Web page.
* New Jersey's Web site lists resolved enforcement actions and shows penalties for violations.
* New York collects data on mortality from coronary artery bypass grafts and other procedures. In 1998 the state also inspected medical residency programs at 12 teaching hospitals to make sure residents were getting adequate rest and time off.
* Pennsylvania publishes detailed reports comparing hospitals' prices and outcomes for coronary artery bypass grafts, breast cancer and diabetes.
* Utah officials attend the final summary session of every Joint Commission survey and pursue their own enforcement actions accordingly.
"States can draw on their own authorities and resources to add a measure of public protection not provided by either HCFA or the Joint Commission," the agency concluded.
This conclusion develops the theme of the four-part series, which argued that HCFA and the Joint Commission should have different tasks and methods in overseeing hospitals and that both perspectives are useful and necessary.
Testimony on how to improve patient safety continued last week at two congressional hearings. Among the industry luminaries voicing their opinions was Kenneth Kizer, M.D., former U.S. Department of Veterans Affairs undersecretary for health and now the president and CEO of the National Quality Forum. He said that today's healthcare is a "high-risk, hazardous activity."
Also testifying was Joint Commission President Dennis O'Leary, M.D., who told the House Ways and Means health subcommittee that providers have the tools and the commitment to reduce medical errors.
Congress has held seven hearings on medical errors since the IOM report was released.
Congress will take the issue on the road, with the first stop in Burlington, Vt. Sen. James Jeffords (R-Vt.), chairman of the Senate Health and Education Committee, will hold a hearing there Feb. 16 to explore federal and state reforms to reduce the number of medical errors in hospitals and other healthcare settings. It will be Jeffords' third hearing on medical errors.
The Senate is considering a bill introduced by Sens. Arlen Specter (R-Pa.) and Tom Harkin (D-Iowa) that would set up a demonstration project to determine the best way to report and learn from medical errors.
At least two other Senate bills are in the works, but none has been introduced.