Cost & Quality Problems

Medical Harm

A critically important area of excess spending and patient suffering is connected to care that is not only unnecessary but actually harms patients.

In 1999, the Institute of Medicine (IOM) estimated that annually 98,000 patients lost their lives due to medical harm.¹ The IOM report sounded an alarm to the country, calling for sweeping changes to the health-care system to improve patient safety.

More recently, three landmark studies revealed no significant progress in improving the safety of patients since the IOM’s report and that the IOM greatly underestimated the amount of medical harm patients experience each year.² The studies looked at all harm—from minor to major—and emphasized the need for a focus on a broader definition of medical harm. Today, our best estimates show that preventable patient harm may be the third-leading cause of death in America.

What is Medical Harm?

Among other things, medical harm³ includes:

• Serious Reportable Events—more commonly called “Never Events;”⁴
• Healthcare acquired conditions;
• healthcare-acquired infections;
• medication errors; and
• diagnostic errors.

While medical harm spans all providers – hospitals, doctors, dialysis centers, nursing homes and outpatient surgical centers—most of what we know of this harm is about hospitals.

Preventable hospital readmissions—another source of wasteful spending—are different, but often connected to hospital-acquired infections and other types of errors.

While known to be large, precise extent of harm not is measured

Of grave concern, while known to be a large problem there’s never been an actual count of how many patients are harmed while receiving medical care. Public hospital reporting systems and internal peer-review capture only a fraction of patient harm or negligent care.

Similarly, there are no comprehensive assessments of the costs that medical errors add to our nation’s healthcare bill. Most studies are limited to the cost of a particular type of event or a particular population. However, we do know that the limited resources devoted to prevention—by hospitals, other healthcare providers and governmental agencies at the state and federal levels—are dwarfed by the resources spent to treat the consequences of this mostly preventable problem. Beyond finances, the human cost is staggering.

The following information provides a partial picture of the cost of medical harm.

• Recent studies estimate that that one in four hospital patients are harmed and that 210,000 to 440,000 of these patients die each year.
• A study revealed that the standard methods hospitals use to detect medical errors fail over 90 percent of the time.
• The average hospitalized patient is subject to at least one medication error per day.⁵ Of these errors, about 20 percent are believed to result in harm.⁶ 
• A 2009 study estimated the annual direct cost of just hospital-acquired infections at $45 billion.

Strategies to Address Medical Harm

The strategies that help reduce patient harm are fairly well understood but unevenly implemented. Key strategies to measure and reduce medical harm include:

• • Improving the accuracy, breadth and standardization of publicly reported medical harm across all settings.
  • Funding training and education of healthcare providers to understand the most effective strategies for reducing medical harm.
  • Aligning financial incentives to harm reduction, such as no payment for serious reportable events, reducing payments to the lowest performers and bundling payments in patient-centered integrated health delivery systems.
  • Create a National Practitioner Data Bank - a database of all state and federal actions against US physicians, including malpractice settlements—available to the public. Currently the data is available but the names of doctors are confidential.

• Establish a National Patient Safety Board—similar to the National Transportation Safety Board and the Consumer Finance Protection Agency—to represent the interests of patients/consumers by monitoring, investigating and promoting healthcare system changes that will lead to the elimination of medical errors.

Notes
1. Kohn LT, Corrigan JM, Donaldson M, eds., To Err Is Human: Building a Safer Health System, Institute of Medicine (1999).
2. Department of Health and Human Services, Office of Inspector General, Adverse Events in Hospitals: National Incidence Among Medicare Beneficiaries, (November 2010); Landrigan, Christopher P., et al , “Temporal Trends in Rates of Patient Harm Resulting from Medical Care” New England Journal of Medicine, Vol. 363, No. 22 (Nov. 25, 2010); Classen, David C., et al., “‘Global Trigger Tool’ Shows that Adverse Events in Hospitals May be Ten Times Greater than Previously Measured,” Health Affairs, Vol. 30, No. 4 (April 2011).
3. For a more complete description, see: Medical Harm: A Taxonomy, Consumers Union, 2015 (forthcoming)
4. These errors are defined as "adverse events that are serious, largely preventable.” A list of “never events” is maintained by the National Quality Forum.
5. Institute of Medicine, Preventing Medication Errors (2006).
6. Rozich JD, et al. “Standardization as a Mechanism to Improve Safety in Healthcare,” Joint Commission Journal on Quality and Patient Safety, Vol. 30, No. 1 (2004); Gleason KM, et al. “Reconciliation of discrepancies in medication histories and admission orders of newly hospitalized patients,” American Journal of Health System Pharmacy (2004).