The cost of medical mistakes

When medical care causes harm that could be avoided, the price is dear and too often those errors cost patients their lives. Now actuaries have put the price of avoidable harm at $17.1 billion in 2008, according to a study published April 7 in the policy journal Health Affairs. On average, the cost per medical error was $11,366. The study abstract (subscription required) identified more than 1.5 million avoidable errors that year.

The results are disappointing but not unexpected, as HHS Secretary Kathleen Sebelius acknowledged in a conference call with reporters last week as she touted one proposed reimbursement model that ties payment to quality performance.

“We've known for a long time that too many Americans fail to get the best care when they walk into a hospital or doctors office,” Sebelius said. “For some patients an error may simply mean they spend more time in the hospital away from their family. For others, like the nearly 100,000 people who die each year from infections they get while receiving care, the cost is far higher.”

“These results are unacceptable,” Sebelius continued. “But when you look at how our healthcare system works, unfortunately they're not surprising.”

As my colleague Maureen McKinney reported, more patients may suffer avoidable harm than previously believed, according to another study published in Health Affairs.

To calculate the number of medical injuries, and those that were likely avoidable, researchers with the actuarial and consulting firm Milliman used commercial health plan claims for 2008. Based on prior research, the study also adjusted figures to account for “false-positives,” or incidents mistakenly identified as a medical injury.

Pressure ulcers claimed the top spot on the researchers list of the 10 most common errors and ranked No. 2 among the most-costly avoidable injuries. The research identified nearly 375,000 avoidable pressure ulcers at an average cost of $8,730.

Postoperative infections ranked as the most costly condition as a result of error and the second-most common preventable condition. An estimated almost 252,700 patients suffered avoidable postoperative infections in 2008 with an added expense of $3.4 billion, or $13,312 per case, on average.

The authors noted the study measured only direct medical costs. Researchers used prior research by researchers at the Medical College of Wisconsin and Children's Hospital of Wisconsin and Medicare's list of “never events” to estimate injury and then “inferred” those likely to be errors. Researchers consulted clinical and actuarial experts to determine the probability an injury was avoidable and used the probability (such as greater than 90%) to estimate error rates. The method and data exclude errors caused when providers fail to treat patients, the authors said, and cost estimates do not include malpractice costs.