Underreported and unaddressed: medical error deaths a big problem

Medical error deaths are estimated to be the third leading cause of death in the United States. However, because medical errors do not have an International Classification of Disease (ICD) code, this is not listed as a cause of death on death certificates or in most rankings. An analysis published in the BMJ from physicians at Johns Hopkins noted that measurements of medical error deaths are out of date, and that internal discussions of human error rarely result in widespread lessons on prevention.

Medical error deaths

Medical error has several definitions, from an act that fails to achieve the desired outcome, an error of execution, an error in planning, or a deviation from the process of care. Patient harm can result either from an individual or systemic level, and the BMJ noted that while many errors are minor, some can accelerate death or cause the death of someone with a long life expectancy.

The impact of such errors is difficult to determine, as a commonly cited estimate of annual medical error deaths comes from a 1999 Institute of Medicine (IOM) report. This report did not involve primary research, and concluded incidence rates of 44,000-98,000 annually based on studies from 1984 and 1992. The article pointed to government reports that suggested these rates are as high as 180,000 among Medicare beneficiaries alone. The authors estimated that medical error deaths fall below heart disease and cancer as the leading causes of death in the country.

A lack of change

The authors call on the Centers for Disease Control and Prevention (CDC) to take action by requiring physicians to report any errors that led to a preventable death. Another physician noted that despite the 1999 IOM report, little change has taken place and the only parameter showing improvement is hospital-acquired infections. He attributed some of the problems to the varying ways in which health care is delivered and a lack of standardization among practices. Although death rates due to medical errors can be alarming, this does not include the amount of severe injuries patients experience due to medical errors, which some estimate is 40 times the death rate.

Government efforts

The hospital-acquired condition (HAC) reduction program was established by section 3008 of the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148) in an effort to draw hospitals’ attention to the problem. Those that rank among the lowest quartile for risk-adjusted HAC quality measures are subject to a reimbursement reduction. In 2014, CMS announced that 721 hospitals were penalized on the basis of three different types of HACs. For fiscal year (FY) 2016, 758 hospitals fell into the lowest quartile and were penalized, which CMS believes will result in a $364 million savings (see $364M projected savings for 2016 under HAC Reduction Program, Health Law Daily, December 16, 2015).