When Stuart was admitted to his local hospital to have his gallbladder removed, he didn't know it would soon become the biggest nightmare of his life. What should have been a routine operation instead placed him in the intensive care unit for six months. Stuart's surgeon had accidentally severed his bile duct, subsequently leading to blood poisoning and multiple organ failure. Over the next several months, Stuart underwent eight additional surgeries. Upon discharge, he was told that he had lost his job. Due to the permanent wasting of his abdominal muscles, Stuart is now unable to lift a full kettle of water and must wear a surgical corset at all times.
Unfortunately, Stuart's case is not an isolated one. New instances of preventable medical errors continue to occur every week. Indeed, a study published in Health Affairs two years ago found that adverse events occurred in as many as one-third of patient admissions, and a report released last year found that 44 percent of adverse events in hospitals were preventable. Earlier last month, news swept the nation that seven California hospitals faced fines amounting to $775,000 for committing preventable medical errors; listed offenses included delaying emergency treatment, performing surgery on the wrong patient, and failing to monitor respiratory status after drug administration. Most alarming were two consecutive offenses committed by the same hospital where operating surgeons left a foreign object in a patient, resulting in a second surgery to remove the retained object. These errors can result in large financial, physical, and psychological burdens on patients, who may be left disabled, unable to care for themselves, or unable to work. Furthermore, preventable medical errors contribute substantially to the economic burden on our nation's healthcare system. The Society of Actuaries estimates that the direct costs of medical error totaled $19.5 billion in 2008. Crucially, these calculations do not factor in some indirect costs, such as loss of productivity and human potential. When these other costs are taken into account, the estimate skyrockets to nearly $1 trillion per year. From this data alone, it is clear that we as a country must address the looming problem of preventable medical errors.
It is important to note that many of preventable medical errors occur are likely related to systems-wide problems like fragmented organization, miscommunication between physicians, nurses, and pharmacists, and look-alike drug vials, and not because of negligence or malice on the part of the individual physician. Therefore, in order to address this problem, physicians, hospitals, and politicians must work together to take a variety of coordinated steps at a national level. Indeed, experts primarily attribute rising incidences of preventable medical errors to the fragmented nature of care provision and the lack of financial incentive to ensure procedural adherence. Fortunately, the Centers of Medicare and Medicaid Services (CMS) has made strides in innovating payment and provider reforms to incentivize quality over volume of services provided. Medicare's Bundled Payments for Care Improvement pilots are an innovative payment model where hospitals are provided flat rate reimbursement for an episode of care. Under this model, physicians must coordinate care and are rewarded for cost-conscious behavior and demonstration of quality clinical performance. To address the lack of financial incentives, Medicare has passed legislation that penalize medical centers on hospital-acquired conditions, which include but are not limited to: retention of foreign objects post-surgery, falls and burns, and various surgical site infections. With these reform measures and others in place, hospitals will hopefully be able to provide high quality, cost-effective care while simultaneously reducing the occurrence of preventable medical errors.
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