It has taken 13 years for us to revisit the issues in To Err Is Human, the 1999 landmark government report that shocked our nation with its revelation that 98,000 people died yearly in hospitals due to doctors' errors. For decades, and through one administration after another, the lack of safety in our healthcare system has gone un-addressed, placing us at greater and greater risk. Hospitals have disappeared, been downsized or have consolidated into vast medical complexes operating like big businesses, with overextended staff spending less and less time with patients due to the fee-for-service paradigm. Adding to this toxic environment are the insurers, who squeeze every dime they can out of the insured by increasing premiums and co-pays and denying coverage for certain procedures at will, while cutting doctors fees for services rendered. A non-system of healthcare seemingly held together with scotch tape and a prayer. The millions who are uninsured are a testament to the failure of an overly costly delivery system that leaves too many without basic healthcare security and coverage. With this as a template for healthcare delivery, how could safety be a part of the package?
Not too long ago, we saw George W. Bush repeatedly diverting attention from the issue of safety in healthcare with fables of frivolous lawsuits and million-dollar pay outs. There is no doubt that this issue is dirty laundry that few in Congress have had the backbone to take on. For many years Public Citizen has issued annual reports honing in on the failures of the Office of Professional Medical Conduct (OPMC) in the states' Health Departments to protect the public by taking minimal action -- if any -- against doctors who have been sanctioned by their hospitals -- a failed agency model that is reactive instead of proactive. (See my Huffington Post article last year "Our Unsafe Healthcare System Is The Issue, Not Caps on Tort Settlements" for more information on this subject.)
At the beginning of the new year, there was a segment on ABC World News on the release of a new report by the Inspector General of Health and Human Services, which oversees Medicare and Medicaid, that found that only one in seven errors and accidents in hospitals are reported. This translates into more than 130,000 Medicare patients being estimated to have experienced one or more adverse episodes in a single month. These staggering numbers were also reported in an Op Ed in the New York Daily News on January 9th of this year. If these are just the numbers reported for Medicare patients, what about those on Medicaid and with private insurance? Is any attempt being made to identify them?
The Op Ed mentioned numerous and varied reasons for these adverse happenings, from ineptitude to medication errors to bedsores and infections. The suggestion was that doctors and support staff don't know what is causing the problem, or they think someone else filed a report, or it was simply a routine occurrence. Basic definitions and code numbers are needed to identify adverse events in hospitals so that they can be charted and solutions found. Instead, they continue to go unreported or underreported, which is against the law. Clearly, little has changed since 1999. We all know a friend or family member who has a hospital-related horror story. Just last week, an echocardiogram technician told me she went to the hospital with kidney stones and developed a hospital-born infection, which left her hospitalized for a month. How much did that cost her and the system?
Some weeks before the Inspector General's report was released, Centers For Medicare and Medicaid Services (CMS) announced its competitively selected 32 Accountable Care Organizations, created under the Affordable Care Act, to participate in a pilot program to provide high-quality, coordinated healthcare and to reduce costs, with new models of healthcare delivery and payment to be implemented in those 32 selected hospitals around the country. Quality standards will be based on patient outcomes and patient experiences, along with coordination of care. This is all part of the transformation in healthcare on the way, with a major focus on e-medical record keeping as the linchpin. Better health and a reduction in hospitalizations are the goals, with an emphasis on primary care. CMS will pay a lump sum for each patient to cover all medical needs. A percentage of the money saved over a three-year period through reduced illness and hospitalizations would then be shared with the hospitals, if quality and performance standards are met. Awarding payment for results is certainly a novel concept in healthcare.
I find it interesting that only one hospital was chosen in New York State to participate in the ACO program, in a state where the nation's leading teaching hospitals and research medical centers are located. 24,000 traditional Medicare patients will be enrolled in this program in New York at Montefiore Medical Center and throughout the Montefiore system. To improve the quality of healthcare, this innovative program should certainly include improving safety among its primary goals. No patient should be fearful of entering a hospital or be at risk of injury or worse. It will be important to follow these pioneer efforts and see how improved healthcare delivery becomes a focus of these ACO's, hopefully at the same time developing safeguards that will eventually be used nationwide. Is a new era in safe, high-quality healthcare delivery with lower costs finally upon us? At least the door now appears to be open.
This post is dedicated to Seth Speken, who died unexpectedly at the age of 23 in a hospital in 1993, and to Christina Zisa, who died at age 27 as a result of injuries sustained during her birth in a hospital. Her lifetime of disabilities ended in January 2011. These were children of personal friends.
- with Jonathan Stone