Health Insurance—Medical Errors and Health Reform

Affordable Care Act May Improve Patient Safety

The Affordable Care Act aimed to improve overall patient safety, but what does experience now tell us? Let's take a look at the reasons behind health reform in reducing medical errors, and the thought behind the changes. At this time we know that medical errors are at an unacceptably high level, and that something needs to change. It's likely, as well, that the change needed is much broader than a few, or even many, rules can accomplish. But in what way has health reformed changed, and how may it continue to change the number of medical errors in the United States?

Medical Errors

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

The correlation between medical errors and death came to the forefront of public knowledge as well, when a 2016 study out of John's Hopkin's University concluded that medical errors were responsible for nearly 10 percent of deaths. To put this in an even clearer, or more ominous way, medical errors appeared to be the third leading cause of death.

While there has been significant debate about the exact numbers, as well as how many of these deaths are preventable, we know that medical errors are an enormous problem in the United States. While there has been considerable debate on many issues, and while medical errors appeared to be declining even before the signing of the Affordable Care Act, there has been a reduction in deaths due to medical errors, at least in the period between 2010 and 2014.

Health Reform As A Way To Reduce Medical Errors

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

Patient Safety Equals Lower Health Care Costs

Recognizing the potential savings that could be accrued by reducing hospital-based medical errors, Medicare identified a number of “reasonably preventable” conditions that are common during a hospital stay. If present during a person's hospitalization, the hospital could not bill for the services given.

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 policies put into place in 2008, the Affordable Care Act uses Medicare payments to hospitals to motivate change. Over time, it is expected that most 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 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 (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 required 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 agreed to provide $75 million annually to improve quality and safety measures.

How Hospitals Compare With Regard to Patient Safety

Medicare, in collaboration with many hospitals around the country, has created Hospital Compare. This online tool can 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.

Initial Thoughts on The Effect of the Affordable Care Act

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. 

Affordable Care Act and Medical Errors, 2010-2014

We now have at least some information on the possible effects of the Affordable Care Act on medical errors. According to the Agency for Healthcare Research and Quality, there was a 17 percent reduction in hospital-acquired conditions between 2010 and 2014. This translates to 87,000 fewer deaths, and a savings of 19.8 billion dollars. While the reduction in errors appears to be leveling off, and despite other issues raised by the ACA, in many ways this is a long overdue change in the direction of medical errors.

Limitations in Understanding Changes in Medical Errors

There are limitations in knowing how much of the reduction in medical errors can be attributed to the Affordable Care Act. Talk about ways to reduce medical errors preceded the introduction of the Act, and it's also noted that the reduction in errors began before it was implemented in 2010. 

Towards Fewer Medical Errors By Being An Empowered Patient

No matter what effect the ACA and Obamacare vs Trumpcare have on patient safety in upcoming years, these changes are not enough to accomplish the reduction we need to see in medical errors. In many ways, your best chance of avoiding medical errors is to be an empowered patient and take time to review ways to reduce your risk. Take some time to learn how to reduce your risk of medication errors. Doing so can take little time and be lifesaving. Take time to review your medical records for errors. Ask a lot of questions and make sure you understand the risks and benefits of any medication or procedure your doctor recommends.

Bottom Line on Medical Errors and Health Reform

One of the goals of the Affordable Care Act was to reduce the number of medical errors, errors that may be responsible for 10 percent of deaths in this country. From the period of 2010 and 2014, it appears to have been effective, though there are many issues which have been raised as well. The bottom line at this time, is that individuals can do something today to reduce their risk, no matter the changes at a National level. Being a wise and empowered patient is one of your best defenses against these errors which remain far too common today.

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