Thursday, July 16, 2009

Save Lives Save Money

100,000 Lives Lost Each Year; $45 Billion Wasted
A critical issue that must be a part of any health care reform initiative is patient safety. Reducing hospital acquired infections and preventing in-facility accidents and medical mistakes will save lives and money.

Consumers Union reports that hospital acquired infections and other preventable medical injuries continue each year to kill 100,000 people and cost the health care system at least $45 Billion dollars. That's no change since the original To Err is Human report was published 10 years ago. Think about that folks ... that's like the airline industry crashing 300 jumbo jets a year with no one raising any serious questions about airline safety practices. And, the failure to respond effectively to this issue has allowed 1,000,000 people to die in the last decade without serious outcry from the public.

I first wrote about this in a two part article that appeared in Richmond Woman magazine in June and July 2005. In the second article, I recommended adoption of a simple proposal that would begin to make patient safety a "bottom line" concern for Virginia hospitals:

It is time to start paying for performance, and rewarding health care institutions that save lives and money. According to Leape and Berwick, “[t]he current reimbursement structure works against improving safety and actually rewards less safe care in many instances.” … In most industries, defects cost money and generate warranty claims. In health care, perversely, under most forms of payment, health care professionals receive a premium for a defective product; physicians and hospitals can bill for the additional services that are needed when patients are injured by their mistakes.” JAMA, May 18, 2005, page 2388.

In a report to Congress on March 1 of this year, the Medicare Payment Advisory Commission concluded, “it is time for the Medicare program to differentiate among providers when making payments.” The Commission called for Congress to instruct the Medicare program to design a pay-for-performance system that rewards improvement, as well as attaining or exceeding certain benchmarks.

It is time for us to call on the Virginia legislature to implement a Medicaid reimbursement system that is structured to reward institutions that implement these safe practices. Private insurers should follow suit.

Since I wrote this, the Medicare system has adopted rules that prohibit reimbursing hospitals and health care institutions for the costs of preventable medical injuries and infections. And, private insurers, including Anthem's parent Wellpoint, have taken action as well.

What has Virginia done?

  • Adopted a "disclosure" law (enacted in 2005 but not effective until July 1, 2008) that requires hospitals to report hospital acquired infections to the CDC and the Board of Health and permits the Board of Health to release the information to the public "upon request." Consumers Union says that this is "not desirable" and that "web based reports are the way to go." Other states have much stronger reporting and disclosure laws.
  • Failed to adopt budget language proposed by Governor Tim Kaine that would have allowed the Department of Medical Assistance Services to issue regulations conforming hospital reimbursements under Medicaid to the federal rule prohibiting Medicare from reimbursing for the costs of preventable medical injuries and infections. The language in the Governor's proposal was:

ZZ. Effective July 1, 2009, the department shall have the authority to amend the State Plan for Medical Assistance to eliminate reimbursement for hospital acquired conditions in a manner similar to the Medicare initiative implemented October 1, 2008. The department shall have the authority to implement this reimbursement change effective July 1, 2009, and prior to the completion of any regulatory process undertaken in order to effect such change. The department shall also revise its medical necessity criteria to be consistent with Medicare national coverage determinations as part of the overall Medicare initiative.

What can you do?

  • If you care about patient safety and reducing the cost of health care, it's time to ask your Virginia legislators why this language wasn't in the final budget adopted during the 2009 Session, and to ask candidates for statewide office or the House of Delegates to commit to support this important change in Medicaid reimbursement rules in the future.
  • In addition, take action though the Consumers Union Safe Patient Project to ensure that this issue gets priority treatment during the debate on health care reform.

Not acting means your loved one may be the next casualty of a system where mistakes pay. Take action now to save lives and save taxpayer dollars.

Safe Patient Project

1) The America's Affordable Health Choices Act of 2009 would require disclosure of hospital acquired infections and conforming Medicaid reimbursement policies to Medicare's. See Subtitle E at page 654 of the introduced bill.
2) A Washington Post article by Lisa Rein published today, Hospitals Tally Their Avoidable Mistakes, includes the following information about recent developments in Virginia:

In Virginia, which so far is requiring reporting only of serious infections caused by IV insertions, the state hospital association is trying to get ahead of the curve: On behalf of the state's 95 hospitals, it reached a deal last month not to bill for several errors caused by hospital staff. "The hope is to send a message that if we make a mistake, we're going to own up and take the consequences," said Katharine Webb, the association's lobbyist.

Anthem Blue Cross and Blue Shield, Virginia's largest private insurer, has stopped paying hospitals for four surgical mistakes: when a wrong procedure is done; when the wrong body part is operated on; when the wrong patient is operated on, and when a foreign object is left inside the patient, requiring another incision. "We wanted to raise the profile of patient safety," said Jay Schukman, regional president and senior medical director for Anthem Blue Cross and Blue Shield's East Region.