Friday, March 11, 2011

Reducing Medical Error

The Washington Monthly has a good article on medical errors and their importance. Well, the importance part is excellent; I’m not sure about the solutions part. Start with the excellence—the problem is pretty big:
In November 2010, the U.S. Department of Health and Human Services issued a study that covered just the 15 percent of the U.S. population enrolled in Medicare. It found that each month one out of seven Medicare hospital patients is injured—and an estimated 15,000 are killed—by harmful medical practice. Treating the consequences of medical errors cost Medicare a full $324 million in October 2008 alone, or 3.5 percent of all Medicare expenditures for inpatient care. Another recent study looked at the incidence of avoidable medical errors across the entire population and concluded that they affected 1.5 million people and cost the U.S. economy $19.5 billion in 2008. The Centers for Disease Control and Prevention have estimated that almost 100,000 Americans now die from hospital-acquired infections alone, and that most of these are preventable.

And:
Americans are exposed to so many CT scans, many of them redundant, that, according to the New England Journal of Medicine,the resulting radiation exposure may be responsible for as much as 2 percent of all cancer deaths in the country.

Now the author, one Marshall Allen, mentions two factors—payment and inaccurate record-keeping—as contributing to this problem. Both of them have at least some merit, but the former has, in my view, more merit. Or—it’s a better place to start. Hospitals do not, generally, face penalties for exposing patients to infections, or unnecessary procedures or scans. In fact, in some ways hospitals are happy to have patients loiter in their system: more time equals more money. So while doctors and administrators at hospitals probably don’t consciously decide to abdicate responsibility for dealing with medical error, it doesn’t really hit them where it hurts either.

That’s why payment reform makes such a big difference: if the mistake hits morally and in the paycheck, people will pay attention and change their ways. Allen talks about all of the specific things that can be done—records, checklists (to make sure, for example, nurses properly insert catheters)—but I think it starts with the meta-reform that motivates all of the other changes. The health reform act made a decent start—hospitals will now be penalized financially for exposing their patients to infections, and then there’s the pilot payment programs—but it remains to be seen whether they work, or even be allowed to try.

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