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Hospital Horror Tales Should Be a Wake-Up Call for Medicare

One of every seven Medicare patients who are hospitalized suffers harm during the inpatient stay, and adverse events in hospitals contribute to the deaths of 180,000 patients a year, according to a new government study. Yet the new Center for Medicare and Medicaid Innovation (CMMI) hasn't even started addressing safety issues. That's a pity, because the dangerous conditions in our hospitals will not succumb to anything less than all-out government action.

CMMI's overriding goals are to improve quality and "bend the cost curve" before Medicare goes broke. Donald Berwick, administrator of the Centers for Medicare and Medicaid Services (CMS), said that these objectives are so urgent that they cannot wait for the seven years it typically takes for CMS demonstration projects.

He's right. But surely the $4.4 billion a year that hospital medical errors cost the government is part of the waste that CMMI aims to eliminate. And, as Berwick knows better than most -- because of his work on safety issues with the Institute for Healthcare Improvement -- we desperately need to jump-start efforts to protect patients when they're most vulnerable.

Time for Berwick to act
Berwick promises that CMS will attack the safety problems in hospitals, and I have no reason to doubt that it will. But perhaps CMS' new innovation center can figure out how to apply some of the same policies it's using to restructure the healthcare system to improve patient safety as well.

The Office of Inspector General in the Department of Health and Human Services, which released the safety report, suggests that Medicare change its financial incentives to hospitals to reduce errors. There has been some progress in that direction: for example, Medicare won't pay for much of the costs resulting from "never events," such as wrong-site surgeries.

The agency also requires hospitals to report on the health problems a patient has on admission, so that it doesn't pay for treating secondary conditions that result from medical treatment. And, beginning Oct. 1, 2012, it will financially penalize hospitals that have excessive readmissions. But obviously, more needs to be done.

A modest proposal
Here's a modest proposal: In CMMI's demonstration of patient-centered medical homes, which are supposed to improve care coordination, include incentives for hospitals to beef up coordination within their own four walls. That might involve paying hospitalists more if they effectively collaborate with the medical and surgical specialists they work with. (Of course, the latter would have to get a piece of the pie, too.)

It might include bonuses for hospitals that reduce error rates, with the proviso that those rewards be divided among nurses and other non-physician clinicians. Incentives could also be provided to hospitals that adopt surgical safety checklists, which have been shown to save lives. Many other creative approaches could be devised under the umbrella of the medical home.

Safety is part of quality, and both must be addressed before we can get costs under control. Healthcare reform must be holistic, or it will fail.

Image supplied courtesy of the U.S. Army.

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