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Keeping medical errors, hospital infections secret costs lives

Consumers Union urges public transparency in our healthcare system so consumers can know about safety, quality and real health costs.

For more information, contact:
Bill Vaughan, Lisa McGiffert, 202-462-6262

The Problem: Lack of information about infections and errorsAmerica’s healthcare system keeps deadly and costly secrets. More than 2 million hospital patients are victims of hospital-acquired infections and medical errors each year, and more than 100,000 of them die. The toll is not just in human suffering. Hospital-acquired infections are estimated to add $45 billion in unnecessary costs to our annual hospital costs alone. Ten years ago the Institutes of Medicine estimated preventable errors add another $17 billion.

While millions are spent each year to educate Americans on preventing heart disease and cancer, a shroud of secrecy engulfs medical errors and infections. We know little about the quality of care given at most facilities, even less about physicians and providers. Many hospitals, physicians and medical associations actively oppose giving consumers this meaningful information.

The federal government has largely failed to respond, focusing more on providers’ needs than the public health threat or the need for comparative quality and cost information. The Centers for Disease Control and Prevention (CDC) leaps into action when infectious diseases erupt – measles and tuberculosis, for example – but it has no similar response or reporting effort on hospital infections and errors, which kill many more. Consumers remain in the dark about the safety, quality and real cost of the hospitals, physicians, and services that they turn to each day. And by keeping this information hidden, healthcare providers have less incentive to do a better job in reducing infections and errors.

The Solution: Public reporting leads to safer, better-quality care
Consumers Union, the nonprofit publisher of Consumer Reports, believes we can end the staggering human and financial toll from preventable errors and infections by committing to a national effort of public transparency and accountability in our health system. And we can begin giving Americans meaningful information about the safety of the care they will get by requiring safety information be collected and made available to the public.

The movement is already underway. Twenty-six states now have laws requiring public reporting of hospital-acquired infection rates. Making infection rates public spurs hospitals to improve their care by actively taking steps to reduce infections – steps as simple as washing hands between patients and raising the head of ventilator patients. Pennsylvania, an early leader in infection-rate reporting, showed an 8 percent reduction in infection rates statewide from 2006 to 2007. While not all hospitals in the state reduced their rates, the majority did, evidence that public reporting leads to improved patient safety.

Additionally, 26 states have systems for hospitals to report medical errors, but only a few reveal this information to the public on a hospital-specific basis. Requiring public reporting of hospital-specific infection rates and errors throughout the nation will help save lives, reduce costs and help consumers get access to valuable information that helps them make better decisions about where to get treatment. This transparency will encourage providers to give the best care possible, and patients will begin to understand what optimal care means and to compare their care to it – no matter where they live. To achieve this goal, we recommend:

Federal action is needed to require public reporting of:
 Healthcare-acquired infection rates for hospitals and other health-care facilities
 Healthcare-acquired infection rates of group practices, as well as individual providers, such as surgeons.
 Medical errors (as defined by the National Quality Forum) by facility, including hospitals, nursing homes and other facilities
 Patient complaints (without patient names), disciplinary orders, fines and sanctions against physicians, other health-care professionals, hospitals and other health facilities.
Information should be:
 Available on the Internet, with the ability to compare among providers, updated quarterly
 Also available in hard copy form upon request
 Easily searchable by name, location and type of practice/facility

The Problem: Paying for poor care, not quality care
For the most part, our healthcare system pays providers for the number of treatments and procedures they do, and pays more for using expensive technology or surgical interventions. It is not designed to reward better quality care or prevention. For example, a 2007 study found Medicaid paid for more than 11 percent of all the hospital-acquired infection cases in our nation. In Pennsylvania, a 2005 study found that 67 percent of that state’s infections were paid for by Medicare, and the average charge for Medicare patients who got a hospital-acquired infection was about $128,000 more than patients without infections.

But recent efforts to change how we pay for care are showing real promise. Since October 2008, the Centers for Medicare and Medicaid Services (CMS) halted hospital payments for care due to harm the hospital caused, including certain hospital-acquired infections. It also prohibits the hospital from billing patients for this care. Infections on the list include catheter-associated urinary tract infections, vascular catheter associated infections, and mediastinitis, a type of infection from bypass surgery.

Numerous states have adopted or are looking to use similar policies for their Medicaid programs. Some private insurers have announced they will no longer pay for these hospital-acquired conditions, and some hospitals are no longer charging for the services associated with them. This demonstrates the incredible power that the federal government has to change the behavior of hospitals and how our healthcare system responds to preventable infections and errors.

Federal action is required to encourage quality care and prevention by:
 Withholding payments for care caused by a medical error or hospital-acquired infections. Use CDC and National Quality Forum definitions for these events, and begin by requiring all government-sponsored healthcare to replicate the Medicare non-payment policies for preventable hospital-acquired conditions. Continue adding conditions to this list each year until all are covered.
 Ensuring patients do not incur costs following a hospital-acquired condition, such as out-of-pocket costs for subsequent surgeries, prescriptions, physical therapy, wound care, etc. Provide for an expedited complaint process in case of extra billing to ensure patients’ costs will be covered following these harmful events.
 Reducing payments to providers, including physicians, who fail to meet optimal levels of safe care.