Patient safety costs employers more than they think

Commentary: Even the best hospitals are not immune to medical mistakes. Take Massachusetts General Hospital. MGH conducted a study on surgeries in its facility and found that nearly every other operation involved at least one medication error (124 out of 277 procedures), usually during the pre-operative phase. Most of the errors involved mistakes in labeling, incorrect dosage, neglecting to treat a problem indicated by the patient's vital signs, and improper documentation. Fully 80% of those were errors were considered preventable.

And if this is happening at one of the nation's most prestigious medical institutions, employers need to think about what may be happening in their local hospitals.

Also see: “HHS program targets patient safety.”

Below are some of the other findings in the MGH study, conducted between November 2013 and June 2014:

• One-third of the medication errors led to an adverse drug event, and the remainder had the potential to cause an adverse event. Of the adverse drug events that were recorded, 20% were not associated with a medication error.
• 30% of the mistakes/errors were considered significant and 69% serious. On the positive side, less than 2% were life threatening and none were fatal. Also, operating room staff intercepted four adverse drug events or medication errors before they affected the patient.
• Medication errors and adverse drug events were more likely to occur during longer procedures, particularly those lasting more than six hours and involving 13 or more medication administrations.

One organization not surprised by the MGH study is the Leapfrog Group. Created in 2000 by a collection of concerned employers, Leapfrog has been surveying hospitals around the country for the past 15 years. About half of the nation's 5,000-plus hospitals respond to Leapfrog Group’s surveys, but nearly all hospitals are either given a patient safety score, from the survey data or based on information from the Centers for Medicare and Medicaid Services. Exceptions include pediatric hospitals, VA hospitals, and hospitals in Maryland, the last of which are not required to publicly report safety information.
Also see: “Leapfrog to CMS: Show us the data.”

Among Leapfrog’s findings over the past decade and a half is that, despite their designation as “centers of excellence,” many highly reputable hospitals have sub-par records in patient safety.

“Safety is a big problem and it is costing employers much more than they realize — in lives and dollars. A big name or reputation doesn’t necessarily mean the hospital is protecting patients from errors and infections the way they should,” says Leapfrog's CEO Leah Binder. “We find major differences among hospitals, and employers would be wise to point employees toward the Hospital Safety Score on our website.” Binder also notes, “many employers use the score in their contracting and benefits design as well.”

Data from Leapfrog's 2015 survey show key shifts among many hospitals on the letter grades rating them on errors, injuries, accidents, and infections, indicating the importance of checking local hospitals' scores. Of the 28 measures used to calculate the A, B, C, D or F grades, on average, hospital performance improved on eight measures, but average performance declined on six measures.

Also see: “Employers can take active role in patient safety.”

At the same time, hospitals are taking steps to make safety a priority, and showing some encouraging results — either by consistently maintaining an “A” score, or by raising a lower score to an “A” over time. Since the launch of the Hospital Safety Score in 2012, 133 hospitals have earned an “A” in each of the twice-annual updates of the Score — approximately 5% of all graded hospitals.

At the other end of the spectrum, 34 hospitals received an “F.” Leapfrog says hospitals have to be severely deficient to be so rated. But even hospitals with “D” and “C” ratings have lots of room for improvement.

Some states do better than others. Maine is a leading example. It has consistently scored high, with nearly 70% of its hospitals receiving an “A” rating. Massachusetts was second with 60%. Over half the hospitals in two other states, Florida and Virginia also received “A” ratings. By contrast, no hospitals in the District of Columbia, Alaska, North Dakota, New Mexico, Vermont, or Wyoming received an A grade. That Maine has scored so well suggests that they should be models for patient safety for hospitals in other states.

Also see: “5 myths about U.S. healthcare: Implications for reform.”

Binder also notes that “despite the powerful stories of improving and high-performing hospitals, improvement across the board remains sluggish. The Fall 2015 update shows a number of positive trends for certain hospital-acquired conditions and safety measures, but hospitals are performing worse on critical measures like foreign objects left in after surgery. Overall, performance on safe practices and process measures varied greatly.”

There are multiple reasons for poor performance in patient safety, including inadequate training and guidelines, overwork, carelessness, and lack of incentives and disincentives to improve. Medicare and some private insurers have stopped paying for costs associated with some mistakes (“never events.”) But until such practice becomes more common and more widely applied – and stricter measures are enforced – errors will continue, healthcare costs will be unnecessarily inflated, and patients will be placed at risk.

What employers can do

Before the advent of business coalitions on health in the early 1980s, most employers were at the mercy of healthcare providers and insurers when it came to costs and quality. Since then, they have flexed their corporate muscles and developed programs designed to make healthcare providers more accountable and healthcare benefits more responsive and affordable. Obamacare makes this all the more important, as more and more Americans have access to healthcare (and its risks.)

Also see: “10 reasons employees hate wellness programs.”

But business pressure has been sorely lacking when it comes to patient safety. Here are some things that employers can do now, none of which involves government regulation:

• Use Leapfrog’s Hospital Safety Score to determine the safety of your local hospitals.
• Use Leapfrog’s Calculator to learn your costs for medical mistakes.
• Insist that patient safety be a priority. Make this point at hospital board meetings.
• Link corporate financial support for hospitals to improvement in patient safety.
• Design healthcare benefits that deny payment for the cost of mistakes.
• Recognize hospitals for improvement in patient safety.

Jan Peter Ozga is president of Medical Business Exchange, a northern Virginia-based consulting firm.