Of 49,827 potential deaths associated with the 86 complications, CMS measures account for only 2% of the total, according to the report. Of the $4 billion in added costs, the federal list accounts only for 13% of the total.
Premier notes that CMS monitors for events such as sepsis, accidental lacerations or punctures, patient falls, surgical-site infections and hypoglycemic coma. However, the agency does not look at other potential complications, such as acute renal failure, hypotension, respiratory failure, transfusion reactions or GI perforation, considered to be high impact in the report.
“Some of these conditions seemed to be occurring relatively frequently, and some had a surprising association with increased mortality,” said Bankowitz, who pointed to examples such as renal failure, which he said happened in about two out of every 100 hospital admissions, and diabetes insipidus, which was associated with a nearly 16% increased risk of mortality.
The report examined more than 5.5 million discharge records from nearly 530 inpatient facilities in the Premier database for federal fiscal 2013. It identified only a broader list of potentially costly conditions, said Bankowitz. But the next step is to create a model to understand the causes and determine which are potentially preventable.
In the meantime, Premier has narrowed its list to a top 10, which it will encourage hospitals to use to understand the frequency of the events in their own institutions and determine if they need action.
Among the 10 listed, only two—sepsis and pulmonary embolism—are included in CMS payment measures. The others include acute renal failure, hypotension, respiratory failure, aspiration pneumonia, gastrointestinal ulceration, cerebral infarction and ventilator-associated pneumonia.
“Don't stop working on measures that are related to payment; they are important. But do not focus exclusively on them,” Bankowitz said. “You will find there are many possibly preventable sources of harm that are highly impactful to patients and families, and highly impactful to costs,” he said.
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