GAO: Hospitals Most Common Subjects in Civil Healthcare Fraud Investigations
Written by Molly Gamble | October 10, 2012Tags: civil fraud cases | DOJ | GAO | healthcare fraud | HHS | hospitals | investigations | Medicaid fraud | Medicare fraud | OIG
Hospitals and medical facilities made up more than one-third of the subjects in civil fraud investigations in 2010, making these facilities the most frequent type of subject, according to a new report from the U.S. Government Accountability Office.Roughly one-third of the 2,339 subjects of civil fraud investigations conducted by HHS' Office of Inspector General and the Department of Justice were hospitals and medical facilities, with the latter encompassing medical centers, clinics or practices. In 2010, 35 percent more subjects were investigated for civil fraud compared with 2005. About half of the subjects who were investigated were pursued. Of the cases pursued, 55 percent resulted in judgments or settlements.
For criminal cases, medical facilities or durable equipment suppliers made up 40 percent of the subjects. Most of the subjects were in cases that were not referred for prosecution, however. Of those that were pursued, most subjects were found guilty or pled guilty or no contest.
In total, 10,187 subjects were investigated for healthcare fraud in 2010 — 7,848 for criminal fraud and 2,339 for civil fraud.
More Articles on Hospitals and Healthcare Fraud:
OIG to Focus on Same-Day Hospital Readmissions, Physician Practice Billing in 2013
20 Recent Lawsuits and Settlements Involving Hospitals
Federal Government: Hospitals Using EHRs for Fraud Will Be Prosecuted
© Copyright ASC COMMUNICATIONS 2012. Interested in LINKING to or REPRINTING this content? View our policies by clicking here.
To receive the latest hospital and health system business and legal news and analysis from Becker's Hospital Review, sign-up for the free Becker's Hospital Review E-weekly by clicking here.
The number of investigations by both the Office of Inspector General (OIG) and of Center for Medicare Services (CMS) is going up dramatically. This is going to put pressure on hospitals to ensure all their data is fully accurate and up to date at all times. Gone are the days when estimations and suppositions for billing and documentation would work. Today and in the future, hospitals and other healthcare providers must have good systems and processes in place to ensure accurate information is being captured as care is given.
For example, a research group that produces reports on organ transplant survival rates is facing delays because of the extra work it must do to determine whether patients are still alive. The federal agency that runs Medicare uses the data to determine whether some transplant programs have such poor track records that they should be cut off from government financing.
“We are not going to be on time until this problem is corrected,” said Dr. Bertram L. Kasiske, a Minneapolis nephrologist who directs the research group, the Scientific Registry of Transplant Recipients. “It’s a big deal. A lot of people look for these reports and depend on them.”
Other medical researchers, including those conducting long-term federally financed studies of cancer and cardiovascular treatments, said the changes imposed last November were now slowing their work significantly. And a spokesman for financial industries like life insurance, banking and credit services said the change was making it more difficult to detect identity thieves who steal names and Social Security numbers from the deceased.
“There is already a consequence — there has to be — because there are fewer records available,” said Stuart Pratt, the president of the Consumer Data Industry Association.
The Social Security Death Master File is an index of 90 million deaths that have been reported to the agency over 75 years by survivors, hospitals, funeral homes and state offices. The listings include names, Social Security numbers and dates of death.
The agency did not make the information public until 1980, after a legal ruling required that the data be disclosed. The list is updated weekly, and although it is neither comprehensive nor 100 percent accurate, it is considered the most current record of deaths nationwide, making it a rich trove for researchers.
It is also far more affordable for researchers than the leading alternative, a death index kept by the federal Centers for Disease Control and Prevention that, while more complete, is typically 14 months to 18 months out of date.
For a decade, the Social Security master file routinely included records provided by the states. But last year, after reports that the widespread availability of death records was facilitating identity theft, the Social Security Administration determined that it had been improperly releasing the state records as part of the file.
Under a 1983 law, the agency concluded, those state records — but only those records — were exempted from public disclosure. They could, however, be made available to other federal agencies, like the Internal Revenue Service and the Centers for Medicare and Medicaid Services, that needed them to determine whether to pay or discontinue benefits.
As a result, four million deaths were expunged from the publicly available master file last November. Social Security officials expect the number of deaths disclosed each year — 2.8 million were made public in 2010 — to decrease by one million.
For epidemiologists, it can be critical to learn quickly when the subject of a study has died so that details can be gathered while memories and records are fresh. Without an updated national index, it can be difficult to track those who have moved repeatedly or perhaps died alone.
Jesse D. Schold, a health researcher at the Cleveland Clinic, said the holes in the master file, which will only grow larger, had already compromised his investigation into mortality rates among living kidney donors.
Confirming deaths of subjects by surveying every state would be prohibitively burdensome, he said. And using the index compiled by the C.D.C., which pays states to submit refined data, would be unaffordable, costing perhaps $30,000 to $50,000 a year.
By contrast, an annual subscription to the Social Security file, with unlimited searches, can be bought for as little as $995. Genealogy Web sites make the data available on the Internet at little or no cost.
“It’s very critical that we have an objective way to measure deaths,” Dr. Schold said. “Otherwise we’re getting the data from the centers we’re measuring, and that’s problematic” because they cannot track all former patients until death.
Gary Chase, the senior project manager of the Nurses’ Health Study, a 36-year Harvard examination of cancer prevalence among more than 200,000 women, said the new policy had “thrown us back to the pre-Internet era, where you’d start looking in the phone book for someone with a similar name and sending out a bunch of letters.”
Greta Lee Splansky, the director of operations for the Framingham Heart Study, which is based at Boston University, said the withheld records meant “the loss of a very valuable tool.”
Over six decades, the study has examined the causes and effects of heart disease in three generations of subjects who were originally from the same town in Massachusetts. Many are dying off. “It just slows us down,” Ms. Splansky said. “It’s wasting research dollars.”
Mark Hinkle, a spokesman for the Social Security Administration, said researchers would simply have to collect the data from the states.
“I don’t want to sound offensive,” Mr. Hinkle said, “but our job is to administer the Social Security program, and administering a death list really isn’t in our core set of workloads. The bottom line is that we have to follow the laws and administer the programs we’re supposed to administer.”
In response to pressure from panicked medical researchers, the C.D.C. hopes to start updating its death index more quickly, but it will not be able to reduce the cost, said Charles J. Rothwell, the director of vital statistics.
Federal agencies with a stake in medical research have been lobbying Social Security officials to consider a compromise.
In Congress, concerns about identity theft — some driven by tax fraud cases involving deceased children — have prompted proposals to restrict access even further.
Representative Sam Johnson, Republican of Texas, has introduced legislation to end the public disclosure of the master file altogether. Senator Bill Nelson, Democrat of Florida, has proposed a bill that would keep death records private until three years after a person died.
Mr. Johnson seems unmoved by the researchers’ plight or by the argument that his bill would hobble the detection of consumer fraud even as it seeks to disarm the thieves.
“The decades-old practice of publishing personal death information that anyone can buy needs to end,” he said, “and now.”
Printing Evolves: An Inkjet for Living Tissue
http://online.wsj.com/article/SB10000872396390443816804578002101200151098.html
Crash diets don't work.
They don't work for losing weight, they don't work for making sales quota and they don't work for getting and keeping a job.
The reason they don't work has nothing to do with what's on the list of things to be done (or consumed). No, the reason they don't work is that they don't change habits, and habits are where our lives and careers and bodies are made.
If you want to get in shape, don't sign up for fancy diet this or Crossthat the other thing. No, the way to get in shape is to go to the gym every single day, change your clothes and take a shower. If you can do that every single day for a month, pretty soon you'll start doing something while you're there...
If you want to make sales quota, get in the habit of making more sales calls, learning more about your market and generally showing up. If you show up, with right intent, you'll start making sales. The secret isn't a great new pitch or a new pair of shoes. The secret is showing up.
Your audacious life goals are fabulous. We're proud of you for having them. But it's possible that those goals are designed to distract you from the thing that's really frightening you--the shift in daily habits that would mean a re-invention of how you see yourself.
Organizations can always benefit from better habits. Every day. Do that first.
I couldn't have said this any better myself. Great work comes from great, everyday, all the time HABITS. It does not come from bursts of work here and there. This goes for every corner, every position of Mobile Aspects. Specifically, Seth Godin gives the example of the sales person who should show up every day with the right intent, every day.
This works for every part and every one in our company. In everything you do, develop great habits that you will do all the time. Great habits lead to great work.
The article from kevinmd.com (a favorite site of mine) below raised a great question: what is the definition of innovation? The article mentions the DaVinci robot used in surgery in hospitals, but is that really innovation? The author says, not really, it is just a fancy way to perform surgery and doesn't necessarily lead to better outcomes (I am not against the DaVinci robot - in fact, we studied the science behind it extensively during my undergrad Biomedical Engineering days at Johns Hopkins).
So back to the question - what is innovation? A lot of people think innovation has to be flashy. It doesn't! An innovation can be as simple as a checklist - a major tool being touted by Dr. Atul Gawande for delivering safer care with much less preventable errors. You could throw a checklist into software, but the software isn't the innovation; it's still the checklist.
In my mind, innovation is a simple tool, or an idea, to deliver a better outcome. That outcome is defined by the marketplace and the user. In healthcare, today, in typically means lower costs, safer care and easier user.
That's what we focus on at Mobile Aspects - helping hospitals deliver care through a simpler workflow and having rich, accurate data. Though everyone looks at our best of breed RFID technology as the innovation, it's actually just the vehicle. Our CTO (Timur Sriharto) and all our engineers are innovators because they work closely with our customers. They see the problems they have on a daily basis in hospital surgery and help them find easier ways to deliver care.
For example, many systems in healthcare want users to login with a text ID and password; some even use biometrics. Our team immediately saw that this is difficult in surgery - caregivers are wearing gloves which can make data entry difficult and the powder from gloves makes biometric thumbprint difficult. While other companies tried to enhance biometric sign in, our team said forget it! We were the first to say - 'You already have an ID card, we'll just use that to login.' There are actually more challenges to this than you would think, but our customers were excited by this simple idea, so we ran after it. Now in our systems, users don't touch a keyboard once, or do any data entry with their fingers- its simplicity in the design that makes our systems so effective and reliable.
That's innovation - a simple tool or idea that brings a better outcome to the end market and user. It can be packaged many ways, but it doesn't need to be more or flashier than that.
In Medicine, Falling for Fake Innovation
A great article by the New York Times on what happens when doctors and clinicians begin thinking about costs of care. As was 25 years ago, today, many clinicians still dont know the costs of items and service. OK... they know whether something is "expensive" or "not expensive", but they generally dont have any further granularity then that.
I dont want my doctor, or any doctor, making decision solely on the cost of items. However, to make decisions completely without knowing the costs? In the end, it actually hurts care... money that could have been spent on another patient is wasted on a different patient because costs were not known. Cost is ONE attribute in delivering care, not the attribute.
We all want what is best for patients across the healthcare spectrum. Its time we start giving hospitals and clinicians more insight into the costs of care. Clinicians can still deliver care optimally, but by knowing the costs, they can determine if something cheaper, but just as effective, could replace it. Overall, this increased the quality of care by leaving dollars on the table to spend on another patient who may need it.
I love data... it dismisses myths, it puts you on the right path, it eliminates emotional decisions and gives you optimal decisions. There are a lot of reports in the media today saying that half of Americans dont pay taxes. As you can see on the chart, in fact, most American's indeed do (82%).
Now if the media said that half of Americans dont pay INCOME taxes they would be right. But when payroll taxes cover Social Security and Medicare, which are two or our biggest budget items, thats a big deal.
In anything, its good to know the detailed facts.. then you can have good discourse in your organization (or in Congress) and make optimal decisions.
I am keeping my eye on this one. The virtualization of spaces and products is quite interesting. This is happening to everything, reducing costs for consumers and businesses. If you think about it, it is quite "lean" - rather than having an always on, fatpipe for TV, this service only provides the proper pipe for a pooled set of users.
With Microsoft complaining about OnLive virtualization and the Entertainment industry coming after Aereo, virtualization will be an interesting space to watch.
In 1874, the inventor Lewis Miller and the Methodist bishop John Heyl Vincent founded a camp for Sunday school teachers near Chautauqua, New York. Two years later, Vincent reinstated the camp, training a collection of teachers in an outdoor summer school. Soon, what had started as an ad-hoc instructional course had become a movement: Secular versions of the outdoor schools, colloquially known as "Chautauquas," began springing up throughout the country, giving rise to an educational circuit featuring lectures and other performances by the intellectuals of the day.
William Jennings Bryan, a frequent presenter at the Chautauquas, called the circuit a "potent human factor in molding the mind of the nation." Teddy Roosevelt deemed it "the most American thing in America."
At the same time, Sinclair Lewis argued, the Chautauqua was "nothing but wind and chaff and ... the laughter of yokels" -- an event, Gregory Mason had it, that was "infinitely easier than trying to think" and that was (said William James) "depressing from its mediocrity."
The more things change, I guess. Compare those conflicted responses to the Chautauqua to the ones leveled at our current incarnation of the highbrow-yet-democratized lecture circuit: TED, the "Technology, Entertainment, and Design" conference. TED is, per contemporary commentators, both "an aspirational peak for the thinking set" and "a McDonald's dishing out servings of Chicken Soup for the Soul." It is both "the official event of digitization" and "a parody of itself."
One matter on which there seems to be no disagreement: TED, today, can make you a star.
TED is a private event that faces the public through its 18-minute-long TED talks -- viewed over 500 million times since they were first put online, wonderfully free of charge, in the summer of 2006. It has pioneered the return of the lecture format in an age that would seem to make that format obsolete. And in converting itself from an exclusive conference to an open platform, TED has become something else, too: one of the most institutionalized systems we have for idea-dissemination in the digital age. To express an idea in the form of a TED talk (and: to sell an idea in the form of a TED talk) is one of the ultimate validations the bustling, chaotic marketplace of ideas can bestow upon one of its denizens. A TED-talked idea is a validated idea. It is, in its way, peer-reviewed.
But the ideas spread through TED, of course, aren't just ideas; they're branded ideas. Packaged ideas. They are ideas stamped not just with the imprimatur of the TED conference and all (the good! the bad! the magical! the miraculous!) that it represents; they're defined as well -- and more directly -- by the person, which is to say the persona, of the speaker who presents them. It's not just "the filter bubble"; it's Eli Pariser on the filter bubble. It's not just the power of introversion in an extrovert-optimized world; it's Susan Cain on the power of introversion. And Seth Godin on digital tribes. And Malcolm Gladwell on spaghetti sauce marketing. And Chris Anderson on the long tail.
It wasn't until the the printed book came along that ideas could be both contained and mass-produced -- and then converted, through that paradox, into commodities.For a platform that sells itself as a manifestation of digital possibility, this approach is surprisingly anachronistic. (Even, you might say, Chautauquan.) In the past, sure, we have insistently associated ideas with the people who first articulated them. Darwin's theory of evolution. Einstein's theory of relativity. Cartesian dualism. Jungian psychology. And on and on and on. (Möbius' strip!) Big ideas have their origin myths, and, historically, those myths have involved the assumption of singular epiphany and individual enlightenment.
But: We live in a world of increasingly networked knowledge. And it's a world that allows us to appreciate what has always been true: that new ideas are never sprung, fully formed, from the heads of the inventors who articulate them, but are always -- always -- the result of discourse and interaction and, in the broadest sense, conversation. The author-ized idea, claimed and owned and bought and sold, has been, it's worth remembering, an accident of technology. Before print came along, ideas were conversational and free-wheeling and collective and, in a very real sense, "spreadable." It wasn't until Gutenberg that ideas could be both contained and mass-produced -- and then converted, through that paradox, into commodities. TED's notion of "ideas worth spreading" -- the implication being that spreading is itself a work of hierarchy and curation -- has its origins in a print-based world of bylines and copyrights. It insists that ideas are, in the digital world, what they have been in the analog: packagable and ownable and claimable.
A TED talk, at this point, is the cultural equivalent of a patent: a private claim to a public concept. With the speaker, himself, becoming the manifestation of the idea. And so: In the name of spreading a concept, the talk ends up narrowing it. Pariser's filter bubble. Anderson's long tail. We talk often about the need for narrative in making abstract concepts relatable to mass audiences; what TED has done so elegantly, though, is to replace narrative in that equation with personality. The relatable idea, TED insists, is the personal idea. It is the performative idea. It is the idea that strides onstage and into a spotlight, ready to become a star.
Image: Wisconsin governor Robert LaFollette addressing a Chautauqua, via the Library of Congress.
I absolutely love TED talks to help inform me and think about things in a new way. I realize, obviously, that much of the discussion is stuff people already know. But a lot of information is stuff that people already know, just repackaged. I often read business books and realize that most of the information is common sense. But it is good to be reminded of the common sense. Ms. Garber also mentions that book printing is when mass commoditization of ideas began. But isnt that ok?
The Washington Post has a great article on the costs of healthcare in the US (please see the link below). The article argues that Americans don't seek more healthcare than other developed countries, yet we are paying nearly double on average on an annual basis. Why is this? The article argues because our system has no pricing transparency.
My favorite quote from the article, however, is:
Health care is an unusual product in that it is difficult, and sometimes impossible, for the customer to say “no.”
I believe price transparency is part of the problem, but not all of it. I still believe (and the article mentions this too) that the easiest way to reduce healthcare costs is by eliminating waste. Let's stop doing things the way we did in the 1980's and update our standards. We will reduce costs and save lives.
Fear of punitive response to hospital errors lingers
Most health professionals remain reluctant to discuss problems or report mistakes freely, despite appeals to hospitals that they stop pointing fingers when things go wrong.
By Kevin B. O'Reilly, amednews staff. Posted Feb. 20, 2012.
For more than a decade, patient safety leaders have urged medicine to shift from an approach that shames and blames individual doctors and nurses for medical errors to a "culture of safety" where open discussion and reporting about adverse events, mistakes, disruptive behavior and unsafe conditions are prized rather than punished.
This less-punitive model of medical-error prevention, inspired by the aviation industry's safety record since the 1980s, is a key element of the Joint Commission requirements hospitals must follow to get paid by Medicare. And a growing body of evidence is showing that higher safety culture scores are correlated with better clinical outcomes and lower rates of hospital-acquired conditions.
Yet data released in February by the Agency for Healthcare Research and Quality show that most physicians, nurses, pharmacists and other health professionals working in hospitals believe their organizations are still more interested in punishing missteps and enforcing hierarchy than in encouraging open communication and using adverse-event reports to learn what's gone wrong.
Half of the nearly 600,000 staffers surveyed at more than 1,110 hospitals nationwide said they believe their mistakes are held against them, and 54% said that when an adverse event is reported, "it feels like the person is being written up, not the problem."
Nearly two-thirds said they worry that mistakes are being held in their personnel file. A little less than half of respondents said they "feel free to question the decisions or actions of those with more authority."
These numbers have not substantially improved since AHRQ released its first patient-safety culture report in 2007. About one-fifth of hospitals have improved their performance in the category of "nonpunitive response to error." But 16% have worsened with time, while the majority of hospitals have treaded water on this key indicator of safe culture. A similar pattern has prevailed on the open-communication metric.
"This is a major problem in hospitals, that we still have this residue of a pretty punitive culture," said James B. Battles, PhD, social science analyst for patient safety at AHRQ's Center for Quality Improvement and Patient Safety in Rockville, Md. "We have our work cut out for us."
How fear hurts safety
A medical setting that discourages adverse event reporting hampers efforts to protect patients from harm, said Bob Wachter, MD, chief of the medical service at the University of California, San Francisco Medical Center.
"You could see how the traditional approach -- an event is reported and someone is written up -- has a hall monitor in elementary school feeling to it," said Dr. Wachter, author of the medical textbook Understanding Patient Safety. "It's extraordinarily destructive in a patient safety context."
37% of hospital staffers say they are afraid to ask questions about a possible error.Simply pledging to avoid finger-pointing after mistakes is not good enough, said Bryan Sexton, PhD, who developed a popular safety-culture survey tool separate from the one used by AHRQ.
"They say all politics is local. Well, all culture is local. That's why it is that we say this is so important and yet we don't see a lot of traction," said Sexton, a medical psychologist and director of the Duke University Health System Patient Safety Center in Durham, N.C.
"We've given more rhetoric than we have resources to this problem in health care."
American Medical Association policy supports nonpunitive mechanisms for reporting safety incidents. The Joint Commission and many patient safety experts say hospitals must create an environment where health professionals feel comfortable admitting mistakes and gaps in knowledge, do not fear discipline or punishment for revealing errors, and where unsafe conditions are identified and addressed. Hospitals are advised to specify that acts of intentional harm or reckless noncompliance with safety protocols will be punished, while promising that other incidents will be investigated with an eye toward preventing future mistakes instead of disciplining the individuals involved.
Implementing such an approach is easier said than done, said Sara J. Singer, PhD, assistant professor in the Dept. of Health Policy and Management at the Harvard School of Public Health in Boston.
"You have to back up a policy like that with repeated, demonstrable acts of organizational learning and systems thinking," said Singer, who has published widely on the link between quality improvement and what she calls the "safety climate" in hospitals.
Patient safety experts said fear of medical liability lawsuits, regulatory action and news media scrutiny also discourage open communication about safety problems. But they noted that those factors are beyond health care organizations' direct control, whereas hospitals can affect the culture that prevails within their walls.
Transparent model may help
Some hospitals have reported steady progress in ditching the shame-and-blame approach. Officials at the University of Illinois Medical Center in Chicago say their policy of investigating and disclosing adverse events to patients and directly offering compensation when appropriate has helped foster a less punitive environment.
In 2005, a year after the hospital adopted its policy, 86% of health professionals said they would not hesitate to report an unanticipated adverse event to the hospital's safety and risk management department. That figure rose to 97% in 2011. The annual number of safety incidents reported by staffers more than quadrupled from 2,000 in 2005 to 9,000 in 2011, including among medical residents. A $3 million grant from AHRQ is aimed at helping other Chicago-area hospitals implement the transparency, disclosure and compensation approach.
Half of hospital staffers say they believe their mistakes are held against them.Fear of discussing safety problems appears less dire in physician practices than it is in hospitals, according to a 2010 AHRQ survey of 470 medical offices. Where 37% of hospital staffers said they "are afraid to ask questions when something does not seem right," only 30% of physicians, nurses and other health professionals or clerical staff in medical offices feel that way. Some 43% of physician-practice respondents said they feel mistakes are held against them, and nearly 60% said "providers and staff talk openly about office problems."
Patient safety experts said it may be easier for physician practices to create less-punitive environments because they are smaller and less bureaucratic than hospitals, and because mistakes in the office setting are less likely to result immediately in serious patient harm. AHRQ plans to survey more physician practices this year and release a report comparing responses over time in 2013.
Leaving shame and blame behind for good is difficult for hospitals, said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Assn. "In some cases, it might be two steps forward and one step back," she said. "That's unfortunately the nature of the beast in developing culture change."
Improving something as seemingly hazy as the cultural mood at a hospital is certainly complicated, but that reality should not be accepted as an excuse, said Harvard's Singer.
"I don't think you should give hospitals a free pass on this," she said. "Yes, it's hard -- and it's critically important that they do it anyway."
ADDITIONAL INFORMATION:
Hospitals get poor marks on handoffs and workload
Lack of open communication and fear of retribution are not the only ways health professionals rate their hospitals poorly. In a recent survey, the following percentages listed other areas that have the potential to hurt safety efforts:
59%: Things "fall between the cracks" when transferring patients from one unit to another.
56%: Problems occur in the exchange of information across hospital units.
55%: Shift changes are problematic for patients.
50%: Workers are in "crisis mode," trying to do too much too quickly.
44%: There is not enough staff to handle the workload.
39%: Hospital management seems interested in patient safety only after an adverse event happens.
38%: It is just by chance that more serious mistakes don't happen around the hospital.
Source: "Hospital Survey on Patient Safety Culture: 2012 user Comparative Database Report," Agency for Healthcare Research and Quality, February (www.ahrq.gov/qual/hospsurvey12)
Weblink
"Hospital Survey on Patient Safety Culture: 2012 User Comparative Database Report," Agency for Healthcare Research and Quality, February (www.ahrq.gov/qual/hospsurvey12)
"2010 Preliminary Comparative Results: Medical Office Survey on Patient Safety Culture," Agency for Healthcare Research and Quality, November 2010 (www.ahrq.gov/qual/mosurvey10/moresults10.htm)
"Identifying organizational cultures that promote patient safety," Health Care Management, October-December 2009 (www.ncbi.nlm.nih.gov/pubmed/19858915)
"Relationship of safety climate and safety performance in hospitals," Health Services Research, April 2009 (www.ncbi.nlm.nih.gov/pubmed/19178583)
Copyright 2012 American Medical Association. All rights reserved.RELATED CONTENT
» Clarity needed on how and when to report medical adverse events Jan. 23
» Revealing their medical errors: Why three doctors went public Aug. 15, 2011
» Patient safety: What can medicine learn from aviation? June 14, 2010
» Hospitals shine light on mistakes by publicly saying: "We're sorry" Aug. 11, 2008
» New culture for coping: Turning to peer support after medical errors Sept. 11, 2006
The past decade has seen a surge of interest in patient safety issues affecting hospital inpatients, spurred in large part by a landmark Institute of Medicine report in 1999 that reported the widespread occurrence of preventable medical errors each year in U.S. hospitals.
Since that IOM study, public policymakers, patient advocacy groups and others have been clamoring for more attention to be paid to the all-too-often deadly problem of inpatient medical errors. Increased research funds in this area -- undoubtedly a good response to such a crisis -- have followed.
- See related content
But every physician knows that the need to be vigilant about protecting every patient's life and well-being doesn't end at the hospital's sliding doors. After all, there are about 300 patient visits conducted in ambulatory care settings for every one hospital admission. Medical errors can and do happen in physician offices, ambulatory surgery centers, skilled nursing facilities and other places where patients receive outpatient care.
Patient safety experts convened by the American Medical Association Center for Patient Safety reviewed roughly 100 studies from 2000 to 2010 that have investigated outpatient safety. In the group's December 2011 report, one of the key conclusions was that such research unnecessarily has taken a back seat over the past decade to research conducted on hospital-based problems.
The ambulatory care studies that have been undertaken give some invaluable insight into safety issues faced in those settings. They document disturbing instances of safety problems, including serious mistakes in diagnosis, prescribing and communication. But although it is clear that these issues are widespread, the body of research does not identify which problems are the most harmful -- and thus deserving not only of additional research, but of extensive corrective action.
Public reports about inpatient hospital errors often focus on the seemingly most egregious cases, such as a doctor operating on the wrong patient or removing the wrong body part. But an office-based physician who does not order the correct medication, fails to follow up on a test result or has insufficient communication with a referring doctor can cause just as much harm to a patient, if not more. Errors of omission can be just as bad as errors of commission, even if they are harder to spot.
The primary barrier in the way of safety improvement is not a lack of will by physicians to do better. If studies can pinpoint the most harmful ambulatory safety issues and give a tangible sense of the scope of the problems, corrective plans with achievable goals can be crafted for everyone to follow. Outpatient safety improvement efforts could be linked with and complemented by inpatient initiatives that already are in place to help prevent hospital readmissions.
Until real data and real solutions are made available, however, the unacceptable status quo will persist despite physicians' best efforts. Especially in this case, knowledge is power.
That's why the AMA report calls for much more robust safety research in the ambulatory care setting. Implementation of the health system reform law will mean an increased focus on using outpatient care to keep patients out of the hospital in the first place, making such a revision in research priorities all the more vital.
Such a systemic shift is not going to be quick and easy, but it is possible. Physicians are committed to their patients no matter where they treat them, and with some more information and guidance, patient safety can become the name of the game in every care setting.
Copyright 2012 American Medical Association. All rights reserved.RELATED CONTENT
» Safety research found lacking for outpatient visits Jan. 9
» $1 billion patient safety effort relies on physician outreach Apr 25, 2011
» Patient safety improving slightly, 10 years after IOM report on errors Dec. 28, 2009
We are still under a sever crisis in the US around patient safety. Two main problems still exist: (1) as this article mentions, the data on patient safety issues in both tertiary hospitals and in other healthcare delivery settings is very poor - it is ambiguous, incomplete and only comes in pockets. (2) The culture of hospitals is still not to report information to both patients and to a general Board at the hospital. The potential fallout from an error is still much worse that the good of reporting it.
People often say we must have National Transportation Safety Board (NTSB) like culture. But its harder than you think - no one can ignore a plane crash. Its a large event, with charred metal broken into pieces and with 100's of people on board. It cannot be ignored.
In healthcare delivery, often times people dont even realize a mistake is made. More important: we must help the caregivers. Let them focus on the patient. We need to watch and observe, come up with suggestions to improve processes, and deliver tools that make their lives easier. That is the best way to improve safety in hospitals, and I see its working already.
