With all the talk of financing and mandates and public options, it's important to make sure the essentials -- that patients are helped, not harmed, by health care -- don't get overlooked. Consumers Union's Safe Patient Project held a daylong event here in DC today to help us keep that in mind.
Roughly 100,000 patients die a year from medical errors and about another 100,000 die of infections acquired in health care settings. "The status quo is not acceptable," Art Levin, director of the Center for Medical Consumers, told the forum.
Consumers Union last May marked the 10th anniversary of the Institute of Medicine's landmark "To Err is Human Report" with a report of its own called "To Err is Human - To Delay is Deadly" (Here's what we wrote about it at the time). The bottom line: not a lot of progress.
The event today highlighted some achievements; the health reform legislation does take some important steps to improve safety and quality. It also sheds a rather depressing light on how much remains to be done.
Robert Wachter, MD, a respected patient safety expert, has a long but fascinating dissection of the recent US Airways landing in the Hudson River, where everyone survived, versus the worst crash ever, when KLM and Pan Am jets crashed on the runway in Tenerife in 1977 . Safety, we conclude after reading his account of how training, culture and technology have changed in the intervening years, is not an accident. He writes:
Can we interest you in some unapproved drugs?
Medicaid is interested. So is the FDA. And Senator Chuck Grassley (R-IA). It seems that from 2004 to 2007, Medicaid spent nearly $198 million paying for prescription drugs that had not gone through FDA safety and effectiveness reviews, according to analysis of federal data by the Associated Press.
Bringing in the bigger picture, the AP notes:
At a time when families, businesses and government are struggling with health care costs and 46 million people are uninsured, payments for questionable medications amount to an unplugged leak in the system.
The FDA estimates that unapproved drugs account for 2 percent of all prescriptions, or about 72 million scripts per year. (Informative FDA video with great sound track here) Many of these drugs provide little or no benefit to the patient. Some are potentially harmful, even deadly, contributing to the some 1.5 million Americans, killed sickened or harmed by preventable medication errors each year.
This year's MacArthur "genius" grants included three extraordinary physician-innovators. All three are practicing physicians, taking care of patients. All three are also showing us how we can improve the whole system, not just for a handful of patients lucky enough to have exceptional doctors. Diane Meier is a pioneer in palliative care, illustrating how we can dramatically improve care for the seriously or terminally ill—and save money while we're at it. Regina Benjamin provides primary care to the poor in unbelievably difficult conditions in rural Alabama. Peter Pronovost is a critical care physician who has shown hospitals simple, inexpensive ways to prevent lethal infections. What's really phenomenal—and different—is that if you try to talk about some of these concepts to policymakers in Washington, at least some of them will know what you are talking about. That wasn't as true just two or three years ago, and I think it shows a growing awareness that health reform has to do more than cover people. It has to cover people in a health care system that is both more efficient and more compassionate.
In 2004, Lance Armstrong revolutionized wristwear awareness with the yellow silicone Livestrong wristbands. Now, hospitals in Alabama hope to raise awareness of patient safety by adopting a standardized system of color-coded wristbands for admitted patients.
Starting in October, no matter what hospital in Alabama a doctor or nurse is working in, a given color wristband on a patient will mean the same thing:
- Red? Check for allergies.
- Yellow? The patient is at risk for falling.
- Neon bangles? Call the 1980s. (Just kidding.)
The program is modeled after an initiative in Arizona and more than 20 states have taken similar steps, according to Montgomery Advertiser. It reflects a growing emphasis in health care on patient safety and the potential impact of simple changes. Let's stress that word simple. Think of how much easier it is for a doctor who may rotate through several hospitals to remember and internalize one set of color signals that could make a huge difference.
Changing anything as complex as health care can lead to unintended consequences and perverse incentives, and some health care providers see the "Never Event" initiative as chock-full of them. (Here's an article from Health Leaders Media, I'll come back to it in a moment.)
The "Never Event" policy means that Medicare will stop paying for certain avoidable errors; some states and major private insurers are following suit. Patients wouldn't have to pay themselves for the extra care, but the hospital wouldn't get reimbursed for the cost. CMS, the agency that runs Medicare, has announced one set, effective this October, and has proposed a second set for 2009 which is still being evaluated and going through the rule-making process. Medicare based its decisions on work by the National Quality Forum (NQF). We'll add both lists to the bottom of this post.
We usually write about health policy, not microbes and science, but sometimes they intersect. MRSA—as the stubborn pathogen methicillin-resistant Staphylococcus aureus is known—is a case in point. Hospitals are debating how to control MRSA, states are debating what policies or mandates will best spur progress, and insurers are increasingly saying that they regard hospital-acquired MRSA infections as an avoidable medical error—and they won't reimburse hospitals for the extra costs of treating it. So we asked Maryn McKenna, a health journalist and author of a book on the CDC and the forthcoming book SUPERBUG: The Rise of Drug-Resistant Staph and the Danger of a World Without Antibiotics to guest blog and catch us up.
Stopping the spread of the stubborn pathogen methicillin-resistant Staphylococcus aureus—MRSA, for short—is one of the most contentious topics in infectious disease policy right now. A small sample of the, umm, highly divergent views on the subject recently filled up the letters and pages of the Journal of the American Medical Association.
(Simple background review: MRSA is a subtype of an extremely common bacterium that, over 40+ years, has become resistant to a wide array of antibiotics used against it. From the late 1960s to the late 1990s, it was primarily a problem within hospitals, where it caused ferocious infections in vulnerable patients. In the 1990s, a community strain arose separately, with fewer resistance factors but greater virulence and an enhanced ability to spread among the apparently healthy. That's the strain responsible for widely reported sudden deaths of children from pneumonia and bone infections.)
Forget star-studded parties in the Hamptons. The most-talked about events in health policy these days are so-called never events—serious preventable medical errors, such as operating on the wrong patient or body part. And if policymakers and payers have their way, never events will someday be non-events.
Medicare helped get the party started when it announced that come October it will stop paying for a series of preventable medical errors that result in serious consequences to patients. Private insurers across the nation have followed suit, and BlueCross and Blue Shield of Illinois, the state's largest insurer, has joined the party, according to the Chicago Tribune.
The Tribune's Bruce Jasper lays out the issue and explains the goals:
The idea is that forcing hospitals to absorb those costs will create an incentive to improve quality of care in a business where money typically rolls in regardless of patient outcomes and customers often feel lost in a complex, impersonal system. [...]
To err is human, and when it comes to medicine, it's especially costly.
Up to 98,000 Americans die each year from preventable medical errors and, according to a new study published Monday in the journal Health Services Research (abstract) preventing mishaps during or after surgery could not only save patients from harm but also save the health care system close to $1.5 billion a year.
Using indicators of patient safety developed by AHRQ, the authors examined insurance claims data for seven categories of preventable adverse medical events—things that shouldn't happen if established guidelines of care were followed. They also looked at data over a three-month period to more accurately reflect the post-discharge costs of readmissions and deaths that occurred as result of a preventable error during or following the initial surgery.
Compared to patients who received appropriate care, the additional costs for patients who experienced the following medical errors were particularly dramatic:
Who said English Lit had nothing to do with health reform? When it comes to stopping the spread of deadly hospital-acquired infections having a room of one's own (although not necessarily a room with a view) can make a big difference, according to today's Los Angeles Times.
The CDC estimates that hospital-acquired infections take close to 100,000 American lives each year. Using the principles of evidence-based design, Bronson Methodist Hospital in Kalamazoo, Michigan reduced infection rates by close to 11 percent by switching from a multi-bed room facility to private rooms. Other design decisions that could improve care include: