Slightly more than two years after the Institute of Medicine reported that 98,000 people die each year from preventable medical errors in hospitals, interest in fixing the problem has waned in Congress.
It may be up to the private sector and state legislatures to come up with standards for patient safety. And there is growing evidence they are up to the task. The Leapfrog Group's completion earlier this month of the first phase of its effort to push hospitals to adopt patient-safety standards (Jan. 21, p. 4) is the most visible example of the leadership role the private sector has taken toward achieving some of the IOM's proposed reforms.
State lawmakers may be gearing up to take on some of the regulatory burden as well, new data show.
Congress failed last year to create a national medical-error reporting system, and as lawmakers reconvened last week, anyone sniffing around Capitol Hill looking for evidence that the issue has come off the back burner was bound to be disappointed.
Moreover, the Centers for Medicare and Medicaid Services has shied away from doing state-based pilot projects to create reporting systems for adverse events.
"On (Capitol Hill) there is not a lot of traction," for patient-safety issues, says Herb Kuhn, vice president of advocacy at the Premier hospital alliance. "Right now the private sector is driving it."
Not all of the private sector, though. American Hospital Association officials have indicated in recent comments that they don't have medical-error legislation on their legislative agenda. In fact, the AHA recently has served as more of an obstacle, rather than a promoter, of other groups' efforts to address the medical-error crisis.
The leading possibility for federal action on medical errors is a bill being drafted by Sens. Edward Kennedy (D-Mass.), William Frist (R-Tenn.), and James Jeffords (I-Vt.) that would create a national database for providers to voluntarily report adverse events. Introduction of the bill was sidetracked last year after Sept. 11, and a Kennedy spokesman said last week that there was no schedule for when the bill would be introduced this year. The spokesman says that a Senate committee hearing on medical-error reporting is being planned, possibly for March.
There is a slim chance that any major legislation on quality will emerge from the House this year. "We're probably going to be having hearings on medical errors and really try to bring that issue to the forefront again," said Deborah Williams, a Republican staff member on the Ways and Means health subcommittee, during a recent healthcare conference in Washington.
With what is expected to be a contentious session in Congress because of the budget deficit and mid-term elections looming in November, the medical-error issue may have difficulty in fighting through other healthcare issues-such as a patients' bill of rights, the healthcare labor shortage and bioterrorism preparedness-for attention in Congress.
"I think it has moved down on the agenda list, but I could see it being easily moved back to the surface," says Kenneth Kizer, M.D., president and chief executive officer of the National Quality Forum, a private agency charged by the federal government with coming up with a national healthcare quality agenda.
Kizer recently appeared on ABC's "Good Morning America" to discuss hospital errors, including a doctor who operated on the wrong side of a patient's head at Rhode Island Hospital in Providence. "It might not be as high on the public agenda, but it is still very much on people's minds," he says.
At the state level, there at least have been signs of some increasing activity on medical errors. Sixty-one bills were introduced in 22 states related to the reduction of medical errors in 2001, compared with 11 bills introduced in five states in 1999, according to unpublished data from the National Academy for State Health Policy in Portland, Maine.
The IOM recommended that a nationwide reporting system for medical errors be established, with collection of information performed by state governments.
Although a network could be developed by states acting individually, there is value in federal leadership, Kizer says.
Earlier this month, the NQF completed its plan for setting up state-based reporting systems for a list of 27 adverse events, which it refers to as "never events." The list includes patient deaths from contaminated drugs and operating on the wrong parts of the body.
The NQF will work with individual states to implement its proposal, but it has dropped plans to partner with the CMS to conduct state pilot projects. "The current administration has apparently no interest in doing those projects," Kizer says.
The AHA was among a small minority of NQF members to vote against the "never event" plan when it was approved by the forum last August.
The AHA, along the Federation of American Hospitals and the Healthcare Leadership Forum, hastily unveiled their new criteria for assessing patient-safety standards just two days before the Leapfrog Group's scheduled press conference to show how hospitals in six regions of the country have adopted its standards.
The hospital groups plugged their timely release as an "effort to collaborate," but they worked alone to develop the criteria by which they feel other groups' more established initiatives should be measured. The Leapfrog Group, which began its standard-setting program 14 months ago, and the Joint Commission on Accreditation of Healthcare Organizations, which started including patient-safety standards in its hospital accreditation survey in July 2001, were not aware of the hospital groups' document until Modern Healthcare faxed them a copy.