Kusserow on Compliance: OIG says 29% of rehab hospital patients experience harm, costing Medicare $100M per year

The HHS Office of Inspector General (OIG) issued a report on evaluation of care provided in rehabilitation (rehab) hospitals, post-acute providers that specialize in intensive rehabilitative care for patients recovering from illness, injury, or surgery.  The OIG noted that while considerable attention in recent years has been paid to patient safety in acute-care hospitals and increasingly in skilled nursing facilities (SNFs), less is known about adverse events in other health care settings. An increased understanding of adverse events that occur in this unique setting would better equip health care providers and other stakeholders in taking actions to improve the safety of patient care in rehab hospitals.

What the OIG found was an estimated 29 percent of Medicare beneficiaries experienced adverse or temporary harm events during their rehab hospital stays, resulting in temporary harm; prolonged stays or transfers to other hospitals; permanent harm; life-sustaining intervention; or death.  This harm rate is in line with what the OIG has reported in the past for hospitals (27 percent) and in SNFs (33 percent). Physician reviewers determined that 46 percent of these adverse and temporary harm events were clearly or likely preventable and much of that was as result of substandard treatment, inadequate patient monitoring, and failure to provide needed treatment. Among the documented preventable incidents of harm were bedsores, medication errors and infections. Study data has suggested medical errors are the third-leading cause of death in the U.S., claiming as many as 250,000 lives a year. However, many disagree with those figures.  Nearly one-quarter of the patients who experienced adverse or temporary harm events had to be transferred to an acute-care hospital for treatment.

To come up with their findings, the OIG reviewed a nationally representative sample of 417 Medicare beneficiaries discharged from rehab hospitals during one month to estimate the national incidence rate, preventability, and costs of adverse events in rehab hospitals.  As result of their study, the OIG recommended:

  • Results of the current study taken with others performed for acute-care hospitals and SNFs confirm the need and opportunity to significantly reduce the incidence of adverse events across health care settings.
  • AHRQ and CMS raise awareness of patient safety issues in rehab hospitals and seek to reduce patient harm. This effort should include: (1) collaboration to create and disseminate a list of potential adverse events that occur in rehab hospitals and (2) the addition of information about potential adverse events in quality guidance to rehab hospitals. CMS and AHRQ concurred with our recommendations.

Richard P. Kusserow served as DHHS Inspector General for 11 years. He currently is CEO of Strategic Management Services, LLC (SM), a firm that has assisted more than 3,000 organizations and entities with compliance related matters. The SM sister company, CRC, provides a wide range of compliance tools including sanction-screening.

Connect with Richard Kusserow on Google+ or LinkedIn.

Subscribe to the Kusserow on Compliance Newsletter

Copyright © 2016 Strategic Management Services, LLC. Published with permission.

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).