Doctor Perspective: Medical Errors
Safety, risk, and quality – the CFO’s other problems
For successful hospital systems, one strategy cuts through the confusing and distracting changes in healthcare: Play defense. Protect the patient to win – clinically and financially.
As I reviewed a recent Johns Hopkins report1 about medical errors rising to become the third-leading cause of death in the United States, I thought about a hospital CFO I worked with long ago whose health system had 5 percent margins on commercial insurance. His credo was, “There is no room for an adverse event that costs $5,000.” Given this number and reality, his primary strategy was simple: “Don’t screw up.”
Success requires defense
In my experience, the leaders in patient safety are at the top because they see the clear link between clinical success and financial success. Perhaps even more critical, they take a systems approach that integrates safety, risk, and quality.
If population health and new revenue sources are offensive plays for hospitals, then playing defense is about defending the patient and your hospital’s margins. It means not spending hard-earned resources to pay for adverse events, catastrophic claims, and broken relationships after systems have failed to keep patients safe.
Offensive tactics to improve population health and bring in money have an essential role. In my mind, though, playing defense in healthcare also has big advantages. Why? Because a systematic approach to patient safety delivers a strong return on investment and protects facilities from the high costs of adverse events. How?
- With a bundled payment model, or in “at risk” value-based care contracts, the effects of an error are especially significant. Errors extend a patient’s length of stay, create direct costs to the system, and increase friction with patients. And in value-based care, all those costs belong to the provider.
- Even in fee-for-service medicine, playing defense to keep patients safe works like a charm financially.
- Finally, it’s easy to gain alignment with your physicians and nurses who see the human costs to patients and the litigation risks of medical errors as something to be avoided “at all costs” (a phrase a CFO normally might find rather irritating). More of us in healthcare are recognizing adverse events for what they are: a threat to financial survival and an opportunity for negative publicity.
The new world: Investing in quality and safety
Investing in the system of care with EMR platforms to document and facilitate care is relatively new. Investments in quality and safety platforms in hospitals to improve the efficacy and safety of the care delivery process are an even newer concept.
Now some of the larger healthcare systems, particularly those with a tight relationship between payer and provider, are using quality management solutions similar to those leveraged by manufacturing companies. Quality systems like ISO 9001 are the backbones of global companies such as BMW, Cadillac, and Johnson & Johnson. These systems decrease variability, leading to consistently safe, quality products – and that means success clinically
and financially.
I’m neither surprised nor panicked about medical errors becoming the third-leading cause of death. As a defensive player, I have the good fortune to work with systems that keep patient safety at the forefront. Investing in safety, quality, and risk is a clinical strategy that makes both our financials and our patients secure. It’s a simple game plan that delivers daily rewards, which makes it easy to feel good about the results.
Patient Information Dissemination
FDA issues draft guidance for device-makers
The U.S. Food and Drug Administration (FDA) issued a draft guidance June 9 on the “Dissemination of Patient-Specific Information from Devices by Device Manufacturers.” The guidance aims to clarify requirements for manufacturers sharing patient-specific information recorded, stored, processed, retrieved, and/or derived from a medical device.
In short, the guidelines say that medical device-makers can share patient-specific information with a patient who is treated or diagnosed with a device if that patient requests it. Patients can also request the information from their physicians.
Device-makers cannot, however, under HIPAA and the associated HIPAA Privacy Rule, share this information with covered entities (e.g., health plans, healthcare providers that electronically transmit health information) without the patient’s consent.
“FDA believes that device manufacturers should take certain considerations into account when sharing patient-specific information to help to ensure it is useable by patients and to avoid the disclosure of confusing or unclear information that could be misinterpreted,” states the guidance. “These considerations relate to the content of information provided, the context in which patient information from medical devices should be understood, and the need for access to additional, follow-up information from the manufacturer or a healthcare provider.”
The full FDA guidance document can be found at fda.gov.
HHS
Certified health IT info gets transparency website
The health IT landscape has traditionally lacked reliable information about the costs, limitations, and tradeoffs of competing health IT products and services. This absence of transparency can make it hard to compare and choose the right system; make it more likely for a user to encounter unexpected costs, implementation issues, and information blocking; and limit incentives for developers to improve their products.
But much of that has changed now.
Starting June 1, the U.S. Department of Health and Human Services (HHS) Office of the National Coordinator for Health Information Technology (ONC) began listing more detailed and easier-to-understand information about certified health information technology. Using a revamped website, potential purchasers of health IT can get a unified view of product offerings and access information about costs and the limitations they may encounter when implementing and using these certified health IT products.
The disclosure of this information is required by ONC’s 2015 Edition Final Rule, which includes several provisions to increase transparency and accountability in the health IT marketplace.
This information is posted on the upgraded certified health IT product list (CHPL) and available on the new website HealthIT.gov/transparency.
Research
The Smart Lighting Engineering Research Center (ERC) at Rensselaer Polytechnic Institute (RPI) in Troy, NY, recently installed a novel hospital inpatient test bed for the study of automated, intelligent lighting at the University of New Mexico Health Sciences Center (UNM-HSC) in Albuquerque. Equipped with smart lighting, the hospital room will enable, for the first time, side-by-side controlled studies of how LED lighting impacts human health. Treatments for depression, Parkinson’s disease, circadian rhythm disorders, and other neurological diseases are on the list of studies to be conducted by UNM researchers.
“In the future, everyone may have access to this technology,” says Lee Brown, M.D., Professor of Internal Medicine and Director of the UNM-HSC Sleep Disorders Program. “Knowing more about the effects of lighting may actually help physicians to prevent disease and increase productivity in healthy persons.”
What’s next? The ERC at RPI is also developing lights that carry data. These LED systems will complement and enlarge Wi-Fi networks with high-speed Li-Fi technology, visible light communications that can operate 100 times faster than some Wi-Fi implementations.
Source: Rensselaer Polytechnic Institute
Opinion: Big Data and Readmissions
Sepsis: The clock is ticking
The high cost of sepsis, bloodstream infections that can become life threatening quickly, may surprise you. By our best estimates, sepsis conservatively accounts for 5 percent of all acute spending annually ($20.3 billion annually and $55.6 million every single day).1
Incentives are not aligned, as Medicare pays four times more for a patient experiencing septic shock than it does for a patient with simple sepsis. Certainly, that is a significant issue, but the more important issue is that the strategy to address sepsis has not evolved since 1974.
In the last 42 years, medical care has not been able to apply a single technology or clinical advancement beyond the identification protocols that remain the “gold standard” for sepsis identification and management. TREWScore, MEWS, and routine screening identify 70 percent of the problem but don’t take into account the precious value of time in the sepsis treatment equation.2
Time truly is of the essence when identifying and treating sepsis. Every hour of delay in the application of effective antibiotics increases mortality by 7.6 percent.3 The clinical indicators and protocols have been fine-tuned to the point that maximum benefit has been achieved, but the combination of a 30 percent miss coupled with the 24 to 26 hours wasted for clinical identification leaves a trail of lives lost and expenses that have risen precipitously. For those lucky enough to survive, “time is tissue.” There are significant, long-term quality-of-life consequences that lead to further hospitalizations and treatment.
In addition, sepsis is a major driver for readmissions, adding another $3.1 billion annually, because sick patients who leave the hospital unidentified as septic will return, compounding the problem and expense. With the gap in communication between acute and post-acute providers, the clock starts all over again as the problem becomes more complicated.
A strategy that leverages big data to identify patients most likely to acquire (or have) sepsis at the point of admission provides care teams with insights leading to protocol-based treatment earlier, making a difference in addressing the survivability and high cost of sepsis.
A change in strategy
Clinical indicators, beginning with a rise in blood pressure, occur on average 15 hours into the 36-hour decline from infection to death.3 But EHR-based alert systems generally require additional validation, resulting in even more time before the initiation of an aggressive sepsis treatment protocol. Intuition also plays a big role, but between nursing staff changes and the communication breakdown among hospital staff and physicians, additional time plagues the process.
With the clock ticking, a strategy that saves time literally saves lives. By leveraging big data and data science, hours can be given back to clinical staff to save lives and reduce immediate and future expenses associated with readmissions and ongoing treatment. There is hope, but the application of data-driven advances requires a real partnership between clinicians and technology.
A 42-year innovation cycle is too long. It’s more than time for some new thinking when it comes to sepsis – and the time is now.
- REFERENCES:
Hall et al., “Inpatient Care for Septicemia or Sepsis: A Challenge for Patients and Hospitals,” NCHS Data Brief, No. 62, June 2011. - Hines et al., HCUP Statistical Brief #172, April 2014, http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient.html.
- Kumar A. et al., Crit Care Med 2006, 34:1286.
