Costly issues untracked by Medicare
A recently released analysis has identified dozens of potentially avoidable hospital complications that are not being tracked by the government even though some occur frequently and are expensive to treat.
Premier, Inc., a consulting company that works with hospitals on improving quality, analyzed 5.5 million patient records to identify 86 common complications that occurred in the hospital and were associated with patient deaths, higher costs or longer lengths of stays. The consultants offered estimates for each condition, which include heart attacks in the hospital, sepsis and acute kidney failure.
Premier said these occurred more often than some of the "narrow" handful of "hospital-acquired conditions" the federal government looks at when setting Medicare payments for hospitals. Since 2008, Medicare has refused to pay extra for patients who develop certain potentially avoidable complications occurring in the hospital, such as when patients are given blood that is incompatible with their own blood type.
Beginning in 2012, Medicare issued financial penalties to hospitals with higher than expected rates of readmissions, which are often caused by conditions that started in the hospital, such as infections. That year, Medicare also started giving incentives and penalties to hospitals based on their mortality rates and other quality factors. This fall, the government will add another layer of penalties to hospitals with the highest rates of infections and avoidable medical mishaps. Medicare has plans to add additional ones each year to its payment formulas.
Premier said it tried to come up with a broader way to measure patient harm for its clients. The conditions it identified cost $4 billion to treat. Of that $558 million were associated with conditions, such as infections from catheters inserted into major veins, that Medicare has tied to financial penalties.
It is far from clear that many of the conditions identified by Premier are things that doctors and nurses could prevent, or even were the primary reasons that a patient’s condition took a bad turn. For instance, Premier estimated 143,682 patients suffered acute kidney failure while in the hospital, adding an average of two days to their stay, each costing an extra $3,410 on average to treat. Those patients had a nearly 2 percent higher chance of dying.
Dr. Richard Bankowitz, Premier’s chief medical officer, said that some of those failures could be caused by the wrong type or amount of drug being administered to the patient. Likewise, a patient could develop pneumonia so severe that the patient could suffer respiratory arrest and need to be put on a ventilator, and further descend into a coma. In that case, prevention efforts would ideally want to focus on avoiding the pneumonia.
"We don’t know how many of them are preventable, but we think some of them might be prevented if we used evidence-based protocols," Bankowitz said in an interview. "What saying to our providers is here is a list of things that happen fairly often and have great consequences when they do occur."
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