As the push for public reporting of medical errors continues, a survey released last week highlighted concerns of healthcare providers that such reporting without confidentiality protection could leave them susceptible to lawsuits.
But pending legislation in Congress protecting the identity of providers who report errors could make those concerns moot.
According to the survey released in the March 16 edition of the Journal of the American Medical Association, 69% of 203 hospital chief executive officers and chief operating officers who responded said a state-run, mandatory reporting system that did not protect the confidentiality of doctors and other hospital staff would deter the self-reporting of errors. Some 79% said such a system would encourage lawsuits, and 73% said it would have a negative effect or no effect on patient safety.
More than 80% of respondents said that if hospitals had to report errors to a state agency, the identity of the reporting staff member and the hospital should be kept confidential.
The release of the survey followed approval on March 9 of the Patient Safety and Quality Improvement Act of 2005 by the Senate Health, Education, Labor and Pensions Committee. The bill, sponsored by Sen. James Jeffords (Ind-Vt.), would guarantee confidentiality for healthcare providers who report medical errors.
At deadline, a vote by the full Senate had not been scheduled, though Senate Majority Leader Bill Frist (R-Tenn.), a heart surgeon, told Modern Healthcare in an e-mail that "I will do everything in my power to pass this good legislation and get it to the president's desk."
A companion bill has not been introduced in the House.
The JAMA study, Frist said, "underscores the need for legislation that will encourage doctors, nurses and other providers to report and fix system errors."
Since 1999, when the Institute of Medicine released its groundbreaking report To Err is Human, which said as many as 98,000 Americans die each year because of avoidable medical errors, the reporting of errors has been highlighted as a necessary and crucial step in improving the quality of care.
Despite that, efforts to create and implement a nationwide system for reporting errors have stalled, in part because of provider concerns. Last year, the same patient-safety bill passed both chambers but never made it out of a conference committee because of the shortened election-year congressional session.
While the results of the JAMA survey were not especially surprising given that its respondents were hospital executives, one of the messages that emerged is that if states make error reporting mandatory, they must use the information to help doctors avoid errors by highlighting best practices, said Joel Weissman, the lead author of the survey and an associate professor of medicine and health policy at Massachusetts General Hospital and Harvard Medical School.
"You need to provide value in exchange for" reporting, he said.
The Senate bill would do so by creating patient-safety organizations that would collect error reports, identify trends and disseminate the information to providers. In giving providers who report errors confidentiality, the patient safety bill also acknowledges providers' concerns. According to the bill, "Many organizations currently collecting patient-safety data have expressed a need for legal protections that will allow them to review protected information and collaborate in the development and implementation of patient-safety improvement strategies. Currently, the state peer-review protections are inadequate to allow the sharing of information to promote patient safety."
Not everyone is convinced doctors and hospitals need such confidentiality protection. Last year, during congressional debate on the bill, some lawmakers expressed concern about such protection, said Ken Kizer, president and CEO of the National Quality Forum, a not-for-profit organization that develops benchmarks for clinical quality-improvement programs.
Within his organization, members are divided on the issue, Kizer said, though he favors public disclosure of the names of institutions where errors occur. He is ambivalent about releasing the names of doctors, he said.
There are indications that when providers own up to their mistakes, patients are less likely to pursue litigation.
A coalition of healthcare providers, lawyers, insurers and others called the Sorry Works Coalition has begun a campaign encourag- ing doctors to disclose their errors to patients and apologize to them for mistakes. And since 2002, the University of Michigan Health System has been encouraging its doctors to apologize when they make a mistake.
Since the effort began, the number of malpractice suits has dropped by half and the system's annual attorney fees have dropped by two-thirds.
Richard Boothman, the University of Michigan Health System's chief risk officer, said the long-term effects of the health system's policy are still unclear and that the decline in lawsuits can be attributed primarily to a more aggressive stand the system has taken against meritless lawsuits.
"It's a very complex issue," he said. "One of the reasons for the fear of open disclosure is that the results can be catastrophic" for providers.