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Employers Role in Patient Safety

Uncomfortable-ShoesHealth premiums paid by employers and their employees are profoundly impacted by health costs, especially when the care was inappropriately delivered.

Since the release of Heartland Health Research Institute’s Silently Harmed white papers, a number of employers have inquired about how they can influence patient safety practices in the hospitals that serve their communities.

To be clear, there are no easy answers. Employers are deservedly frustrated with the perceived leverage they have to influence necessary progress on this issue that dually impacts costs, and most importantly, lives. When it comes to patient safety, there appears to be just enough self-interest group regulation that precludes the public from igniting a patient revolution.

It has been said that revolutions never happen in comfortable shoes – and so it goes with healthcare.

Healthy organizations require healthy employees. From the employer perspective, ‘patient safety’ should be equally balanced with two other initiatives: affordability and high-quality outcomes. This ‘holy trinity’ of value – cost, quality and safety – serve as the cohesive bond for all payers – government, carriers and employers. Armed with the right information, employers can play a proactive role in changing the healthcare delivery landscape that is currently going through a seismic evolution (if not a revolution). In fact, now is the time for employers to inject their influence to a mammoth industry that requires major disruption.

Employers, assisted by carriers, can begin to craft health plans that reward safety practices and discourage (or penalize) non-compliance, urging hospital boards to make patient safety a priority. This can be done by insisting that providers implement safety measures that demonstrate adherence to patient safety cultures. By leveraging this new role, employers can educate their employees on how they can engage more effectively with their healthcare partners to receive better care. Distributing patient safety literature to employees and family members can serve as important reminders for patients to proactively seek care from providers who have proven to give the right care at the right time. Visiting the National Patient Safety Foundation website can be a great first step to increase awareness about patient safety issues. There are many other organizations promoting quality and safety measures, such as The Leapfrog Group, which cleverly includes a ‘hidden surcharge calculator‘ for Leapfrog members to calculate their average annual hidden hospital surcharge resulting from medical errors.

Iowa is served by very capable and well-intentioned providers. But the question is not as much about the people who care for us, rather, the ‘systems’ in which they operate. Due largely to self-interest concerns, medicine is unable to regulate itself voluntarily – it needs a push from those who have much at stake – employers and other purchasers.

Employers can and must promote patient safety measures when purchasing health coverage. There is no better time than now for this to happen.

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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.

To stay abreast of employee benefits and other tangential issues, we invite you to subscribe to this blog.

‘Silently Harmed’ White Papers Now Released!

Silently Harmed - Hospital Medical Errors in the HeartlandToday, Heartland Health Research Institute (HHRI), a nonprofit Iowa organization established last Fall, has released a family of white papers, Silently Harmed – Hospital Medical Errors in the Heartland©.

A new state-specific report was released in Iowa and in each of its six neighboring states estimating the number of hospitalized patients who are seriously- or fatally-harmed annually due to largely unreported or under-reported preventable medical errors.

The seven individual ‘Silently Harmed’ white papers cover the following states:

  1. Illinois
  2. Iowa
  3. Minnesota
  4. Missouri
  5. Nebraska
  6. South Dakota
  7. Wisconsin

The eighth report, ‘Hospital Medical Errors in the Heartland,’ combines the statistics of all seven states within one report.

Using credible, national estimates on the prevalence of preventable adverse events (PAEs), HHRI reports state-specific estimates for the number of patients harmed in hospitals. In addition to estimating patients harmed both seriously and fatally, the report suggests the social costs of patients harmed can range from $1 billion to $24 billion annually, just in Iowa. This estimate greatly varies by each Heartland state.

Thanks largely to the Dartmouth Atlas of Health Care, we know that care-quality varies widely in different parts of the country, state and even across town. Due to the subjective nature of assigning quality ratings to each state, the report does not make assumptions about quality of care in Iowa or any other Heartland state when estimating the number of patients harmed in hospitals.

Until the release of these reports, the discussion concerning the number of preventable medical errors was generally focused on national estimates, with scant estimates being allocated at the state level.

In addition to the state reports, HHRI has developed state-specific infographics that summarize key data from the ‘Silently Harmed’ white papers.

To learn more about the ‘Silently Harmed’ reports and infographics, in addition to information about HHRI, please visit our new HHRI website.

Going forward, blog posts found on the David P. Lind Benchmark website will address information more specific to employee benefits and other tangential subject matter. The HHRI website will also post blogs, but the subject matter will concentrate on healthcare-related issues that are not specific to employee benefits. Should subscribers from this site also wish to subscribe to HHRI blogs, you are invited to do so here.

To stay abreast of employee benefits issues, we invite you to subscribe to our blog.