A new look at how many Medicare patients are injured and killed by their care in hospitals has armed the CMS with cause to become more deeply involved in efforts to improve quality and safety.
A heavy toll
Study: 13.5% of Medicare patients harmed
One in seven Medicare patients hospitalized suffered an adverse event, broadly defined as harm to patient caused by medical care, according to an analysis by HHS' inspector general's office of a random sample of 780 Medicare beneficiaries hospitalized in October 2008. The portion of those patients who suffered adverse events extrapolates out to about 134,000 patients in that single month and 1.6 million over a full year.
An equal number suffered less serious harm that required medical intervention (including some patients who experienced both types), and Medicare likely paid $4.4 billion, 3.5% of its inpatient budget, to pay for the treatment connected to the events. The results indicate that adverse events “contributed” to about 180,000 deaths that year.
The inspector general's office pulled medical records for the patients and commissioned physicians to review them to determine whether they suffered adverse events and whether those events were on the National Quality Forum's list of “serious reportable events” or Medicare's list of hospital-acquired conditions.
CMS Administrator Donald Berwick and Carolyn Clancy, director of HHS' Agency for Healthcare Research and Quality, responded to Inspector General Daniel Levinson that they supported the recommendation in the report, the first of which is that they broaden patient safety efforts to reflect the wider universe of events captured in the report.
Few of them—about 1%—are captured by Medicare's efforts to identify conditions acquired during hospital stays and to stop paying hospitals more for treating things they caused or failed to prevent.
Also, only 0.6% of the adverse events were ones that would have been on the National Quality Forum's list of serious reportable events. Even many of the gravest incidents discovered in the sample were not represented on the NQF list, which focuses on a specific set of events. Of 18 incidents in the sample that caused serious disability or death, only two were on the list, according to the report.
“This report suggests you'd have to be a daredevil to allow yourself to be admitted to a hospital,” said Leah Binder, CEO of the Leapfrog Group. “What other industry in human history has a rate of injury like that? Maybe tightrope walkers or people who get shot out of cannons.”
Berwick responded to the findings and recommendations in a 10-page letter. Berwick said the agency intends to attack the problem, using such things as the criteria for meaningful use of health information technology and the financial incentives of value-based purchasing.
Nancy Foster, the American Hospital Association's vice president for quality and patient safety, cautioned that the methodology may lead the public to think the numbers reflect only preventable medical errors.
NQF President and CEO Janet Corrigan noted that the list of serious reportable events has grown broader since the year the inspector general's office drew its sample.
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