News: One quarter of Medicare patients harmed in hospitals, OIG reports

Twenty-five percent of hospitalized Medicare patients experience patient harm, and 43% of those harm events could have been prevented according to a recent report from the Health and Human Services Office of Inspector General (OIG). Medication-related harm was the most common at 43%, followed by patient care-related harm at 23%, procedural and surgical harm at 22%, and infections at 11%.

In the study, patient harm was defined as both adverse events and temporary harm events. Adverse events lead to longer hospital stays, permanent harm, life-saving intervention, or death. Temporary harm events require intervention but do not cause lasting harm, longer hospital stays, or life-sustaining measures—though in some records the OIG reviewed, only thanks to early intervention.

This study looked at a random sample of inpatient records from 2018 and was conducted to remeasure the national incidence rate following a 2010 report, which found 27% of Medicare patients experienced harm during their hospital stay. Despite efforts in the last decade to improve patient safety, the new OIG report indicates the challenge remains persistent for the Agency for Healthcare Research and Quality (AHRQ) and CMS, the main national agencies responsible for promoting quality healthcare and preventing patient harm.

“None of us would drive a vehicle or check into a hotel if we thought we had a one in four chance of being harmed from the experience,” Leah Binder, president and CEO of the Leapfrog Group, told MedPage Today.

CMS does have policies designed to deter hospital-acquired conditions (HAC). But, as the report points out, "because the policies use narrowly scoped lists of HACs and employ specific criteria for counting harm events, they have limited effectiveness in broadly promoting patient safety. Of the harm events we identified, only 5% were on CMS's HAC Reduction Program [HACRP] list and only 2% were on CMS's Deficit Reduction Act HAC list."

For instance, CMS currently counts infections associated with a surgical procedure only if they involve the colon or an abdominal hysterectomy, MedPage Today reported. This means many other infections, such as those following a laminectomy, go uncounted. 

But CMS’ fiscal year 2023 inpatient prospective payment system (IPPS) proposed rule currently steers the agency away from including more types of harm in its formula for penalizing hospitals. 

“The agency is moving rapidly in the opposite direction, not growing the number of measures, but removing all the HACs and HAIs [healthcare-associated infections] from payment consideration,” Binder explained. “CMS's proposed rule calls for suppressing all HACs and HAIs from use . . . and replac[es] them with nothing."

The OIG report concludes that substantial efforts are needed to incentivize hospitals. “Only the worst 25% of performers receive the 1% reduction each year,” the OIG states. “Hospitals that routinely are in the top three quarters of performance do not have a financial incentive through the HACRP to improve more.”

The OIG made three recommendations to CMS to help reduce patient harm:

1. "Update and broaden its lists of HACs to capture common, preventable, and high-cost harm events;
2. Explore expanding the use of patient safety metrics in pilots and demonstrations for healthcare payment and service delivery, as appropriate; and
3. Develop and release interpretive guidance to surveyors for assessing hospital compliance with requirements to track and monitor patient harm."

The report also gave four recommendations to the AHRQ as well:

1. "Coordinate agency efforts to update agency-specific Quality Strategic Plans;
2. Optimize use of the Quality and Safety Review System, including assessing the feasibility of automating data capture for national measurement and to facilitate local use;
3. Develop an effective model to disseminate information on national clinical practice guidelines or best practices to improve patient safety; and
4. Continue efforts to identify and develop new strategies to prevent common patient harm events in hospitals."

Editor’s note: To read MedPage Today’s coverage of this story, click here. To read the full OIG report, “Adverse Events in Hospitals: A Quarter of Medicare Patients Experienced Harm in October 2018,” click here.