Public Pressure May Make Hospitals Safer

By Trudy Lieberman, Rural Health News Service

Trudy Lieberman talks Health
Trudy Lieberman talks Health

Medicare has just announced it is penalizing more than 700 of the nation’s hospitals because they have higher rates of patient safety mishaps, which the government and patient advocacy groups have been trying for years to prevent.

What are those incidents that have resulted in a one percent cut in a hospital’s Medicare payments over the year? They are mistakes you wouldn’t want to have happen to you or a family member, things like infections caused by incisions made during colon surgeries and hysterectomies, by urinary catheters and by central lines inserted into a large vein to draw blood and administer fluids and medicines.

UCLA Medical Staff
                                       UCLA Medical Staff

Those infections cause thousands of deaths each year. Most are preventable and they account for three-fourths of Medicare’s safety score. The rest of the assessment is based on eight other complications such as collapsed lungs, broken hips, surgical tears, and wounds that opened.

What’s significant is not that so many hospitals apparently are still not taking steps to prevent these common and well-documented harms to patients, but that so many of the hospitals are stars in their communities advertising for local patients. Others are marquee names that advertise their medical prowess nationally.

As I read down the state-by-state roster of those facilities that were penalized, I found hospitals well-known in their regions: Cedars-Sinai Medical Center and the Ronald Reagan UCLA Medical Center in Los Angeles; the Denver Health Medical Center; Northwestern Memorial Hospital in Chicago; Indiana University Health in Indianapolis; and the Nebraska Medical Center in Omaha.

Medicare also penalized the Cleveland Clinic and a couple of hospitals in the Mayo Clinic system in Minnesota. Both the Clinic and Mayo are heavy promoters of their brand in an effort to build a national patient base. Some big advertisers in my home state of New York also showed up on the government’s list.

Chicago Cook County Hospital
        Chicago Cook County Hospital Emergency Entrance

But as government data show, spending big bucks to promote the hospital brand doesn’t necessarily mean the hospital has a better safety profile.

This is the second year the government has released safety penalties that were authorized by the Affordable Care Act. As you browse through the list of   hospitals, you’ll see that more than half of those penalized this year also were penalized last year. The ACA requires that one-quarter of the hospitals that can be penalized (VA, children’s and critical access hospitals cannot be) will receive some penalty even if all the hospitals improve. Penalizing those in the bottom quarter is a way to encourage continuous quality improvement, explained Jordan Rau who reports on the topic for Kaiser Health News.

And that, of course, brings up the obvious question: Why are so many hospitals this year making the same medical mistakes they made last year especially since the errors are preventable?

The answer is complicated and calls into question a hospital’s commitment to safety, a subject I have explored several times with Ashish Jha, professor of public health at the Harvard School of Public Health and one of the country’s experts on patient safety.

He told me there has been “clear progress” with reductions in surgical site infections and central line infections, which are down 40 to 50 percent nationally. Yet he said that as many as half all hospitals are not using a simple checklist that calls for four steps including hand washing and wearing sterile gloves to cut down on infections.

“The field of patient safety is full of stories about amazing interventions that can save patients’ lives but do not end up getting widely adopted,” he explained.

“Why?” I asked.

“It really isn’t anyone’s priority except maybe the patient’s,” Jha said. “How many times have you heard stories about hospital CEOs getting fired because of the hospital’s infection rates? I haven’t.” He added there’s also no evidence that high infection rates or high mortality rates have any effect on CEO salaries

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