Thursday, August 12, 2010

$20 billion may not be the whole story

In case you missed this, preventable medical errors costed the country $19.5 billion in 2008 — or roughly $13,000 for each avoidable case, according to a report published Monday by the Society of Actuaries (SOA).

Maybe I missed them in the document, but I didn't find central line infections, ventilator associated pneumonia, spread of MRSA, failure in timely recognition of patient deterioration, failure to diagnose, and other conditions that can result from systemic flaws in the delivery of care. If so, the number is understated.

For example, we found remarkable cost savings resulted from avoiding ventilator associated pneumonia in our hospital alone. As discussed below:

Preventing 744 cases over three years -- at a treatment cost of about $20,000 per case -- translates into a societal savings of $14.9 million during this period.

Whether $20 billion or more, the report presents yet another compelling reason to eliminate preventable harm in our hospitals.


Anonymous said...

The figure that spoke to me was:

"In an inpatient setting, seven percent of admissions are estimated to result in some type of medical injury."

Seven percent - wow. That seems at least 6.5 percent too high, just at a glance.

nonlocal MD

Jeffrey N. Catalano said...

There is much truth to that. In fact, the cost of treating those injured by medical errors may be as much as $29 to $38 billion per year according to a study published by VanGeest, Jonathan B., and Deborah S. Cummins, Ph.D., National Patient Safety Foundation, An Educational Needs Assessment for Improving Patient Safety.

Anonymous said...

We need a universal mechanism for learning from one another's mistakes. That is my goal in promoting my panel for the 2011 South-by-Southwest (SXSW) Interactive, next March in Austin, Texas. Let's put something together that every healthcare provider--orderly, nurse, surgeon, anesthesiologist, physician--is comfortable using to report lessons learned from mistakes that makes them preventable errors. Got to and vote for Life-Saving Errors: Health 2.0 Incident Reporting.

And if that's not already enough of a shameless plug, I still need a couple of social-media-savvy physicians for the panel.

Anonymous said...

Central line infections are in there. See "Infection due to central venous catheter".

Unknown said...

I have an idea. In order to save costs, we can simply not treat these in-hospital acquired conditions. Or better yet, we can stop treating patients in hospitals altogether...the savings would be enormous.

Is it me, or is it inane that we simply post numerators without denominators? The cost of hospital acquired issues and deaths is high...but it is substantially lower than if did not have hospitals. Pundits have somehow managed to cast a shadow over our healthcare and has gotten everyone to believe that no one dies, unless it is caused by a doctor, nurse, or other health professional. Can we all accept a little dose of reality?

Mark Graban said...

I think a more interesting question, instead of quibbling over the exact $$ figures or exact percentages is the question "What will it take to convince every hospital to adopt the proven checklists methodology - see Pronovost and WHO - to eliminate central line infections?"

If the number in that study were $200B a year, would that prompt more action? Why is there not more action if the number is only just $20B? What if we forget the numbers and just do the right thing?

Engineer on Medicare said...

It would be interesting if the Society of Actuaries would calculate the societal cost of prolonging life by medical means. Someone who dies as a result of a medical error ceases to be a user of Medicare and Social Security, pensions cease, and the cost of late-life care and treating of diseases of the elderly would be reduced.

What would be the effect on the economy if treatment for chronic and terminal diseases was not available to anyone beyone retirement age?

Unknown said...

The costs to society are high indeed. But for post-surgical complications, with a few recent exceptions, hospitals only experience in reduction in their profit margin. In a 2006 publication (J Am Coll Surg), Justin Dimick and his colleagues showed that, for an average complication, the hospital they studied suffered a profit margin reduction of about $2,500. It's still a big number, but not enough, it seems, to create a stampede among hospitals to reduce post-surgical complications or to join the American College of Surgeons National Surgical Improvement Program.

Anonymous said...

As to Mark and Dan's comments, I have long ago given up on the idea of doing the right thing being sufficient motivation in modern medicine, for whatever reason. However, it would seem the fastest way to implement the desired changes is to make them part of either CMS or Joint Commission accreditation requirements. Why this has not happened, be it concern for adequate evidence or the 'lethal lag time', is not clear to me.