Health Insurance: Medical Errors and Health Reform

Affordable Care Act May Improve Patient Safety

Medical Errors - The Affordable Care Act may help improve patient safety in hospitals. jsmith/iStockphoto

The Affordable Care Act aims to improve overall patient safety.

Can Health Reform Reduce Medical Errors?

The statistics are well known to physicians, pharmacists, hospital administrators, and many patients: preventable medical errors kill and seriously injure hundreds of thousands of Americans every single year!

In fact, if the Centers for Disease Control and Prevention (CDC) included “preventable medical errors” as a disease-specific category, it would be the sixth leading cause of death in the U.S.

Although the primary focus of the Affordable Care Act (health reform legislation) signed into law in March 2010 is to provide access to affordable health insurance for all Americans, the legislation has a number of provisions that may improve patient safety.

Patient Safety = Lower Health Care Costs

Concerned about patient safety and recognizing the potential savings of reducing hospital-based medical errors? Medicare identified a number of “reasonably preventable” conditions you could get during a hospital stay. These hospital-acquired conditions or problems would not be reimbursed and the hospital could not bill you if you were affected.

These rules went into effect in 2008 before the passage of the Affordable Care Act. Not unexpectedly, several large private health insurance companies, including Aetna and the Blue Cross/ Blue Shield Association among others, implemented similar policies not to pay hospitals and physicians for care related to medical complications that should not typically occur during a hospitalization.

The goal of these policies is to save lives and save money by having hospitals implement new procedures to prevent errors.

Transparency and New Incentives for Patient Safety

Building on the Medicare hospital safety polices put into place in 2008, the Affordable Care Act uses Medicare payments to hospitals to motivate change.

Over time, it is expected that private insurance companies will follow the lead of Medicare – this should affect you regardless of the health plan that pays your hospital bills.

The following provisions in the health reform law should lay the groundwork for needed change:

  • Hospitals with better outcomes related to the care of strokes and heart attacks, and prevention of infections will receive higher payments.
  • Hospitals with high readmission rates for heart failure and high rates of hospital-acquired conditions such as infections, bed sores, and falls will be penalized with reduced payments.
  • Medicare will track a hospital’s error rates and in 2014 will cut payment by 1 percent to hospitals with the highest rates of patient safety issues.

To assure that you are aware of these safety measures and to share how hospitals improve, the Affordable Care Act requires Medicare to:

  • Publish each hospital’s medical error track record
  • Create a Patient-Centered Outcomes Research Institute that will recommend the most effective treatments
  • Establish The Center for Quality Improvement and Patient Safety to research improvements in patient safety

As part of health reform, the federal government will provide $75 million annually to improve quality and safety measures.

Patient Safety - How Does Your Hospital Compare?

Medicare, in collaboration with many hospitals around the country, has created Hospital Compare. This online tool will help you find information on how well hospitals in your community care for patients with certain medical conditions or surgical procedures, and results from a survey of patients about the quality of care they received during a recent hospital stay. This information may help you compare the quality of care hospitals provide and help you make a decision about what will be best for you if you need hospital care.

Some of the medical conditions compared include heart attack, heart failure, chronic lung disease, pneumonia, diabetes in adults, and chest pain. Some of the surgical procedures include heart bypass surgery, pacemaker implant, gallbladder surgery, hernia surgery, bowel surgery, back and neck surgery major joint replacement, prostate surgery, and female reproductive surgery.

Some Warnings About Hospital Compare

The information on the Hospital Compare website comes from hospitals that have agreed to submit quality information for Hospital Compare to make public. Your hospital may not be listed. And, if you are in a managed care plan (HMO or PPO), the hospital you want to use may not be in your health plan’s provider network.

However, you should be able to track any hospital’s medical error track record.

But, Will It Work?

With a strong emphasis on quality improvement and a clear “carrot and stick” approach to hospital reimbursement, it is likely that hospital care will change for the better over the long term. However, with all of the other changes in the health system expected from health reform, the demands (both financial and the increased numbers of patients needing services) on hospitals and physicians – especially Primary Care Physicians – are likely to be significant, if not chaotic.

Learn More About Medical Errors

I highly recommend that you read the following articles for more information:

Continue Reading