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Having the BHAG to shoot for the Moon

Did you know that up to 440,000 lives are lost annually in our hospitals due to preventable mistakes?

Because of this, we desperately need a Big, Harry, Audacious Goal (or BHAG) to solve this national tragedy, and it cannot happen soon enough. By the way, BHAG was a phrase coined by author Jim Collins.

On May 25, 1961, President John F. Kennedy addressed a joint session of Congress stating that the U.S. should set a goal of “landing a man on the moon and returning him safely to the earth” by the end of the decade. By making this bold statement, Kennedy captured the attention, imagination and collective will of our country. Eight years later, his BHAG was accomplished. Amazingly, we put a man on the moon using 1960’s technology.

In December 1999, the Institute of Medicine (IOM) released a seminal book, ‘To Err is Human: Building a Safer Health System.’ This book raised eyebrows and presumably generated supposed action. Using the annual estimate of 98,000 preventable hospital deaths, the IOM report attempted to galvanize this frightening number of avoidable deaths and set forth a worthy goal: “Given current knowledge about the magnitude of the problem, the (IOM) committee believes it would be irresponsible to expect anything less than a 50 percent reduction in errors over five years.”

Was the IOM goal reached in five years? No. In 15 years? Definitely not. Based on recent reports, preventable hospital deaths in the U.S. are greater than previously understood.

In 2013, the Journal of Patient Safety estimated that up to 440,000 lives may be lost annually in our hospitals due to preventable errors – over four times the number reported by the IOM. This equates to three jumbo jets falling from our sky EACH DAY, incurring 1,200 casualties. Another 10- to 20-times this number are seriously injured in our hospitals due to preventable errors. At best, we are making glacial progress.

Since the IOM report was released, the estimated number of lives lost due to hospital errors is alarming – between 1,470,000 and 6,600,000. Why such a chasm in numbers? Most errors go unreported for various egregious reasons. Our cobbled ‘system’ may kill as many people every eight days than were lost on 9/11 and in the Iraq and Afghanistan wars (9,469). Since 1999, more Americans have needlessly died in our hospitals than had died or were wounded throughout our entire history of wars (2.7 million).

‘To Err Is Human’ suggests that the problem is not bad people working in healthcare, but good people working in bad ‘systems.’ It is ironic that the very system we trust to ‘do no harm’ causes a great deal of lethal harm. Unlike actual jets falling from the sky, lives lost in our hospitals happen silently, one at a time. These fatal errors cannot be managed and improved if they are not first acknowledged and measured. Trust must be earned in healthcare, not blindly given. Without broad and consistent public outrage, this national tragedy will continue to persist with little hope of sustained improvement.

In our 2014 Iowa Employer Benefits Study, a top priority of Iowa employers is patients’ safety of care. Employers correctly perceive the safety issue has been inadequately addressed.

Because healthcare is local, solutions must be local. Hospital board members must insist that patient safety is paramount in setting their hospital’s long-term vision and mission. Their safety culture should permeate throughout the entire organization through policies, decision making, resource allocation, and most importantly, complete public transparency. Embracing this culture with words alone is nothing more than deceptive marketing fluff that silently kills.

If efforts to reach the moon were similar to how we confront safety of care, we would still be floating in boundless black space with little hope of reaching our destination. The BHAG we need in healthcare safety should be nothing short of landing on the moon by having the courageous willpower to get there – just like we did in the ’60s.

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Feeding Medicare’s Infrastructure

Mother Robin Feeds Young in NestMuch like a mother robin feeding her young, Medicare continues to ‘feed’ the infrastructure that serves our elderly – but, with a great deal of waste and inefficiency.

In their recent book, ‘Medicare Meltdown: How Wall Street and Washington are Ruining Medicare and How to Fix It,’ co-authors Rosemary Gibson (aka health care ‘rock star’) and Janardan Prasad Singh, spend a chapter on ‘Fifteen Medicare Facts That Will Astonish You.’ Learning astonishing facts can be fun. But when those facts relate to Medicare, they can be extremely sobering.

Perhaps you can use one or many of these facts to ‘wow’ guests at your next dinner party. Better yet, use them when meeting with those elected to Congress.

1. If Medicare were a country, it would be the 20th largest economy in the world.
That’s right, larger than the entire economy of Sweden – and double that of Ireland!

2. Medicare wastes the equivalent of New Zealand’s entire economy.
In 2011, Medicare spent $560 billion, yet about 30 percent ($170 billion) was wasted and did not benefit our seniors. Where did it go? Blame it on overtreatment, inefficiencies and poor management. (Source: Institute of Medicine)

3. Between now and 2030, Medicare will be adding population equivalents of Austria, Hong Kong, Israel and Switzerland to its rolls.
In 2013, about 49 million people were covered by Medicare, and in 17 years (2030), an estimated 33 million more Americans will be covered.

4. Ten thousand boomers sign up for Medicare every day.
That’s 10 thousand per day for the next 20 years!

5. During a lifetime of work, the average person pays $60,000 for Medicare.
Look at your pay stub, this is the money deducted for the Medicare payroll tax.

6. A new retiree can expect to receive about $180,000 in Medicare benefits.
A person pays in $60,000 and expects to receive, on average, $180,000 in benefits. Economics 101 can’t explain this type of math – unless we mortgage our future.

7. Your federal income taxes pay for a growing share of Medicare’s costs.
Subtract #5 above from #6 (answer: $120,000). From this amount, seniors pay for hospital outpatient care and doctor visits (Part B) and prescription drugs (Part D). The rest is paid by federal income taxes and borrowing – which raises the federal debt.

8. The number of corporate healthcare firms on the Fortune 100 list has increased from zero in 1965 to 15 today.
These firms have benefited greatly from the current Medicare infrastructure. According to Gibson and Singh, the ties that bind Wall Street and Washington in the healthcare industry are strong and their interests are often at odds with those of seniors and boomers.

9. The federal government borrows money from China to pay Medicare bills from hospitals, doctors and drug companies.
Currently, interest rates are low, but can (and will) change in the future. This is not good for our long-term debt problem.

10. President Obama and Rush Limbaugh agree on this fact.
Paying for Medicare is not sustainable at the rate these costs are growing.

11. Between now and 2035, the healthcare industry will reap from Medicare a larger share of the country’s gross domestic product.
As Medicare grows, the federal government will have less money to pay for the nation’s infrastructure, investments in science and technology, education and national security. According to the Congressional Budget Office, if we do nothing to curb this cost, Medicare will consume nearly 25 percent of the value of all goods and services our country produces by 2082. In 2006, Medicare spending was at three percent of GDP.

12. The number of doctors who specialize in caring for seniors is shrinking when more are needed.
The median salary for geriatricians is lower than almost all specialties, threatening the number of new doctors willing to fill this growing role.

13. Medicare’s money for hospital care begins to run out in 2024.
This fact about Medicare Part A comes from a non-partisan report by the Medicare trustees.

14. An estimated, 79,200 Medicare beneficiaries die each year because of preventable harm in hospitals.
This is just an estimate. We really don’t know because actual data of those fatally harmed is seldom reported on a consistent basis. Based on a 2013 report in the Journal of Patient Safety, this number could be much higher.

15. Annual Medicare fraud and abuse is equivalent to one million seniors’ lifetime Medicare contributions.
FBI fraud estimates can be up to 10 percent of what Medicare spends – about $60 billion. In addition, this amount does not include the mistakes made in coding payments and calculating the money Medicare owes to providers. In 2010, Medicare estimated $48 billion was made in ‘improper payments.’

‘Medicare Meltdown’ not only points out the problems but provides a road map on how Medicare can be fixed in the future. Much of what we need is the political willpower to make changes so that we can efficiently provide the necessary care to our seniors.

After all, a mother robin has only so much food to distribute.

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What do 1,100 Jumbo Jets and Preventable Medical Errors have in Common?

How about a quick quiz?

Trivia Question #1: How many passengers fit in a typical jumbo jet?

Answer: Generally between 350 and 450, so let’s say an average of 400 passengers.

Trivia Question #2: How many premature deaths occur in U.S. hospitals each year, associated with preventable medical errors?

Answer: According to a recent article in the Journal of Patient Safety, enough to fill 1,100 jumbo jets each year – which equates to approximately 440,000 passengers. This is not a typo. The article is titled, “A New, Evidence-based Estimate of Patient Harms Associated with Hospital Care.”

If remotely accurate, this statistic is both disturbing and entirely unacceptable!

Using the 2010 census, the population of five counties in the greater Des Moines metropolitan area (Polk, Dallas, Warren, Madison, and Guthrie) was 569,633 people. If this article is correct, the entire population of the Des Moines metro area would be gone in 15.5 months due to preventable hospital errors. This would quickly demand our collective attention, don’t you think? Why hasn’t this been reported by the media? It finally has — in this article, “To Make Hospitals Less deadly, A Dose of Data.”

If the Centers for Disease Control (CDC) were to include preventable medical errors in hospitals as a category, the conclusions found in this article would make it the third leading cause of death in the United States. Based on 2010 data, the CDC’s top five leading causes of death were:

  • Heart Disease – 597,689
  • Cancer – 574,743
  • Preventable Medical Errors Associated with Hospital Care – ~440,000
  • Chronic lower respiratory diseases – 138,080
  • Stroke (cerebrovascular diseases) – 129,476
  • Accidents (unintentional injuries) – 120,859

In 2000, the Institute of Medicine (IOM) published a seminal book, “To Err is Human.” This book revealed that as many as 98,000 people die every year due to medical errors. At the time, this number appeared to be bold – so bold that it was attacked by some. Now in 2013, another report suggests the IOM number is less than one-quarter of the true estimated casualties found in our nation’s hospitals.

I presume these medical errors occur regardless of having insurance coverage or not. Health insurance is certainly important for all Americans, but having it does not guarantee receiving safe care.

Without a doubt, Americans can agree that safe and efficient health care delivery is sorely needed. Having just one jumbo jet fall from the sky is entirely unacceptable.

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