The late Wilbur Cohen, one of Medicare's chief architects, noted it wasn't a glitch that prevented the federal program from policing the practice of medicine, including its safety and quality. Rather, that was a design feature.
“Sponsors of Medicare, including myself, had to concede in 1965 that there would be no real controls over hospitals and physicians,” Cohen said. “I was required to promise before the final vote ... that the federal agency would exercise no control.”
Nearly a half century after Medicare's founding and 15 years after the Institute of Medicine's landmark report “To Err Is Human” ignited concerns about patient safety, the nation still doesn't have an effective set of regulations to protect people once they have entered the healthcare delivery system. Medicare's watchdog, HHS' Office of the Inspector General, recently said adverse events in hospitals contribute to about 15,000 deaths a month, and another 134,000 less-severe injuries.
And that's only an estimate, since state and federally mandated recordkeeping is spotty and hospitals' internal reporting systems capture only 13% of events, according to an inspector general report. And when patients complain, their concerns often end in bureaucratic paper trails and staff-training videos shown in hospital conference rooms, a troubling response in today's fiscal environment, as unnecessary medical errors add billions of dollars annually to healthcare spending.
The lack of progress has led many safety advocates to call for more aggressive regulatory actions by the government, which picks up half the national healthcare tab. “We need the health equivalent of the Federal Aviation Administration, which sets the rules and then enforces them. And then the National Transportation Safety Board, which investigates accidents,” said Dr. Lucian Leape, the influential Harvard professor and an institute chairman at the National Patient Safety Foundation. “We need to have that in healthcare, and I don't see that happening.”