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‘Silently Harmed’ in Iowa – Bare Essentials

Silently-Harmed-IowaThe Silently Harmed white papers recently published by nonprofit, Heartland Health Research Institute, reveal a largely unknown problem in Iowa and nationwide. It is the number of patients seriously- and fatally-harmed in hospitals due to medical errors, also known as preventable adverse events (PAEs).

In addition to the state of Iowa, Silently Harmed provides estimated ranges of PAEs for a number of critical metrics in each of Iowa’s six neighboring states: Illinois, Minnesota, Missouri, Nebraska, South Dakota and Wisconsin. The difference between patients seriously- or fatally-harmed in each of the seven ‘Heartland’ states – as estimated in Silently Harmed – is a reflection of the number of inpatient admissions reported for each state – a metric primarily driven by state population.

Let’s review the highlights from Silently Harmed in Iowa.

Digging in-slide 1 (2)In 2012, hospitals in the United States had 34.8 million admissions, while during that same year, Iowa hospitals had about one percent of that number, or 340,000 admissions. It is important to note that Silently Harmed did not provide estimates for outpatient settings, such as doctors’ offices, nursing homes, outpatient surgeries, etc.

The annual estimated number of patients seriously- and fatally-harmed in U.S. hospitals due to PAEs is nothing short of staggering. Because PAEs go largely underreported or unreported, the national estimations vary wildly – primarily because the referenced national studies use a variety of research assumptions and methods that reach disparate conclusions that may or may not relate to each individual state. The slide below provides low- and high-end estimates for patients seriously- and fatally-harmed within U.S. hospitals.

Digging Deep Down

Seriously Harmed
From national estimates, HHRI extrapolated that as few as 64,500 patients are harmed in Iowa hospitals due to PAEs, with a high-end of 112,200 patients. The mid-range estimate of 85,000 patients are harmed in Iowa hospitals due to medical errors – enough to fill BOTH Kinnick Stadium and the Hilton Coliseum. Assuming the mid-range estimate is true, one patient is harmed every six minutes, or one in every four hospital admissions. In just one week, over 1,630 patients are harmed.

Seriously Harmed in Iowa

Fatally Harmed
Extrapolating from national estimated fatalities, annual Iowa fatalities from PAEs are 960 at the low-end, with 4,300 fatalities at the high-end. The mid-range estimate of 2,440 fatalities would mean that one fatality occurs every four hours, or one in every 139 admissions. Put another way, almost seven patients die from PAEs for every vehicle death in Iowa. For every murder in Iowa, 57 die from medical errors.

Fatally Harmed in Iowa

Social Cost of Mistakes
According to the Robert Wood Johnson Foundation, poor quality of care costs employers between $1,900 – $2,250 per employee per year, or about one-third of the single-employer premium in Iowa. The social cost of medical mistakes is massive. Social cost is determined by the “value of a statistical life,” a term used by economists. The estimated social cost for injuries due to medical mistakes can range from $909 million to $1.6 billion annually – just in Iowa. For fatally-harmed patients, the social cost ranges from $5.3 billion to almost $24 billion annually.

Social Cost of Mistakes

The estimated numbers provided in this particular post, in addition to the specifics on how these numbers were determined, are found in our free white paper, Silently Harmed: Hospital Medical Errors in Iowa.

Since the release of the Silently Harmed white papers, a number of employers have inquired about how their role must evolve to influence patient safety practices in the hospitals that serve their communities. We will address the employer role regarding patient safety issues in an upcoming blog.

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A New Employer Mindset Needed
Avoid Repeating Healthcare ‘Time Loop’

Time LoopIn the 1993 movie, “Groundhog Day,” actor Bill Murray plays a Pittsburgh TV weatherman who finds himself in a comical time loop while covering the annual Groundhog Day event in Punxsutawney, PA. Murray’s character wakes up each day to relive February 2 and eventually learns how to use his prior-day experiences to make a difference within Punxsutawney. But it takes him many, many attempts and frustrations before he realizes he must re-examine his life and priorities before he can make desired progress.

I was recently approached by a very large Iowa organization interested to know my ‘take’ on the next phase of employer-based health coverage. Specifically, I was asked how to break the endless cycle of doing the same things over and over again to control health costs – as current attempts seemingly do not move the cost needle.

This particular organization assuredly represents most employers when it comes to the frustration of offering health coverage to their workforce. Much like the Murray character, employers continue to relive their renewals, year-after-year, only to repeat past practices that invariably result in a similar and familiar fate. A handful of these annual activities typically include the following:

  • Changing insurance companies or third-party vendors, including pharmacy benefit managers, wellness vendors, insurance brokers, etc.
  • Increasing employee cost-sharing components, such as deductibles, co-payments and out-of-pocket maximums
  • Limiting (or expanding) provider networks
  • Embracing consumer-driven health plans
  • Converting to a new financial mechanism to pay for coverage, such as self-funding, partial self-funding and a host of other hybrid funding arrangements

To avoid repeating similar (and predictable) results from these practices, employers should take a page from Murray and re-examine their priorities. Here are three ‘takes’ that I shared with this particular organization:

  1. Employers Must Recognize and Accept that Preventable Medical Mistakes is a HUGE Problem

    Employers should not assume employees and their family members will consistently receive safe and appropriate care from the local provider community. Even the best and most prestigious hospitals are not immune from committing these errors. Preventable mistakes are VERY costly, both in lives and in money. According to the Robert Wood Johnson Foundation, poor quality-of-care costs employers at least a third of the single-health premium. In Iowa, this would conservatively amount to $1,850 per employee each year. The social costs due to preventable medical errors dwarf this amount.* Just as importantly, eliminating preventable mistakes will also result in employees and family members living healthier and more productive lives.

  2. Insist that Patient Safety becomes a PRIORITY

    In the past, employers have relied on healthcare providers and insurance companies to control costs and quality, assuming that patient safety was naturally baked into the services we purchase. Yet, employers unknowingly pay for medical errors – albeit at the lower-negotiated fee available through insurers – but such discounted ‘savings’ are eventually negated due to paying for undocumented preventable mistakes. Employers and employees (not insurers) are the ultimate payers for this wasteful and unnecessary cost through higher insurance premiums. And, because of this, they must insist that new health plans deny payment for preventable medical errors. At the very least, this should be a minimum requirement. Few private plans attempt to do this, primarily because they have scant metrics to detect these errors. How would they know?

  3. Require public TRANSPARENCY from local providers

    The word ‘transparency’ has become an overused word – especially within healthcare. But for the ultimate payers of healthcare (employers and employees) to determine the value they receive from the ‘investment’ they make, the provider community must enter the 21st Century and demonstrate their value by publicly reporting comparable and usable safety information. This should also be a minimum requirement.

Offering and paying for expensive health insurance coverage year-after-year is the ‘Groundhog Day’ confronting frustrated employers. Unless a new mindset takes hold in the employer community that can forever alter our perpetual ‘Groundhog Day,’ very little will change in our ‘town’ of Punxsutawney.

*Additional details to follow over the next month.

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Confronting THE ‘Silent Killer’

Silent Killer

Keeping silent. What IS the third leading cause of death in the U.S.?

The safety of the people shall be the highest law.
Marcus Tullius Cicero

A democratic society values freedom of speech, protection from harm and unjust imprisonment. Unfortunately, one of these values has been glaringly absent for some time.

While preparing this particular blog, I am reminded that countless towns, cities and states have silly, if not outrageous ordinances and laws. Take Iowa – some laws have been on the books for many years and are grossly outdated – most likely due to oversight or just plain laziness. For example:

  • A man with a moustache may never kiss a woman in public.
  • One-armed piano players must perform for free.
  • Kisses may last for no more than five minutes.
  • In Dubuque, any hotel in the city limits must have a water bucket and a hitching post in front of the building.
  • Marshalltown forbids horses to eat fire hydrants.

If these comical, yet ridiculous laws are still in existence (some are now repealed), can you imagine just how many ‘violations’ have occurred since they were implemented? Having such laws or ordinances legislated to control harmless acts within our towns and state borders are quite meaningless, don’t you think?

So then, why are we not concerned about having legitimate legislation that attempts to protect every patient from harm, even when the harm is mostly ‘silent’ and assumed to be unintended? Allow me to explain…

If the Centers for Disease Control (CDC) were to include preventable medical errors in hospitals as a category, it would be the third leading cause of death in the United States, behind heart disease and cancer. When it comes to reporting these mistakes around the country, however, doctors and nurses have been fired when they speak up. This code of silence is, to say the least, deafening. Medical errors, no doubt, have become THE ‘silent killer.’

In its 1999 “To Err Is Human” report, the Institute of Medicine (IOM) called for a nationwide, mandatory reporting system for state governments to collect standardized information about “adverse medical events” resulting in death and serious harm. Interestingly, this call for a national reporting system was not implemented.

However, as of November 2014, 27 states and the District of Columbia now have variations of authorized adverse event reporting systems. Oregon’s reporting system is voluntary. As of this January, Texas now reports such events. Many of Iowa’s neighboring states, such as Illinois, Minnesota and South Dakota have reporting requirements.

What about Iowa? Not much.

To improve the care we receive, we first must understand how prevalent this problem is in Iowa and elsewhere. In 2010, Harvard published a report in the New England Journal of Medicine indicating that about 25 percent of all patients are harmed by medical mistakes. In 2014, Massachusetts completed a survey of its residents and determined that 23 percent received medical errors.

So are preventable medical errors in Iowa similar to these alarming reports, or is care provided within our borders somehow insulated from the dismal results found elsewhere? That becomes the big question – we simply don’t know. In Iowa, we have no independent trusted source to publicly provide ongoing transparency about this ‘silent killer.’

A quote from noted cancer surgeon, Dr. Marty Makary, refers to the importance of openness and transparency – which easily applies to this particular subject matter:

“Health care costs are not going to be reigned by different ways of financing our system, but by making it more transparent so that patients can fix the system. I’m convinced that the government is not going to fix health care. And doctors are not going to fix health care. It’s going to be the patients.”

There are different ways to scale over this ‘Wall of Silence.’ Perhaps a good, first step may be to establish reporting requirements, much like the other 27 states are now doing. By taking this approach, health workers who desire to do the right thing by reporting errors can be protected from workplace retaliations. Another, more immediate strategy is to ask Iowans about their experiences – a simple process that establishes a baseline for later, more deliberate, actionable solutions to make safety-of-care a statewide priority. To ultimately improve patient safety and quality, public reporting and provider feedback is critical.

We must not tolerate secrecy and demand ‘sunlight’ within the medical care we receive. A preventable medical error becomes egregiously INTENTIONAL when nothing is done to prevent it from occurring again in the future. By staying quiet, opportunities to learn and improve the quality of care will be lost.

Now, well into the 21st Century, it is time to assess which laws best serve our citizens. Limiting a kiss to five minutes does not have the life-changing consequence when compared to addressing and eliminating THE ‘silent killer’ of our time.

Isn’t it time to take action? I welcome your thoughts on this very important issue.

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