Strategies to Improve Medicare Patient Safety During Hospitalization
Over the last decade, negligence from health practitioners has contributed to the increase in Medicare patient harm and complications during their stay in the hospital. According to the latest study from the HHS Office of Inspector General (OIG), a quarter of older Medicare patients suffer harm and complications during hospitalization.
“COVID-19 is another factor that contributed to the increased rate of harm and complications for Medicare patients,” says Berkowitz Hanna Malpractice & Injury Lawyers. COVID-19 took a toll on American hospitals, putting medical providers under pressure to treat as many patients as possible; resulting in gaps in patient safety. All of these factors raise serious concerns, and as a result, there have been attempts to find initiatives that will improve patient safety.
Statistics of Medicare Patients Harmed During Hospitalization
The Office of Inspector General (OIG) studied the medical records of 770 Medicare patients discharged from acute care hospitals in October of 2018. After this study, OIG discovered that 12 percent of patients suffered harm resulting in extended hospital stays, life-saving interventions, irreversible injury, or death.
Additionally, 13 percent of patients suffered harm that required intervention but did not result in permanent injury, extended hospital stays, or the need for life-sustaining measures. This group of patients are considered to have experienced temporary harm events. The most common causes of both the temporary and permanent harm events include:
- Medication which accounted for 43%
- Patient care which accounted for 23%
- Procedures and surgeries which accounted for 22%, and
- Infections which accounted for 11%
According to a review by physicians who assisted with the study, nearly half of the harm events were preventable. In particular, 43 percent of events were considered preventable, most being due to inadequate care. The remaining cases were likely unavoidable because of factors like difficulty in patient condition.
Significant Regulatory Strategies to Improve Patient Safety
Over the last decade, federal agencies in charge of patient safety have worked to reduce the rate of harm and complications patients face during hospitalization. The agencies include the Centers for Medicare and Medicaid Services (CMS) and The Agency for Healthcare Research and Quality (AHRQ).
These agencies are aiming to improve patient safety by limiting medical errors, minimizing medication mix-ups, and holding hospitals with poor patient safety records accountable. One initiative accomplishing this is the Medicare Hospital-Acquired Condition (HAC) Reduction Program, which penalizes hospitals that perform poorly based on specific safety measures. These measures include:
- Surgical Site Infection (SSI) after abdominal hysterectomy and colon procedures
- Composite of Patient Safety and Adverse Events (CMS PSI 90)
- Central Line-Associated Bloodstream Infection (CLABSI)
- Clostridium Difficile Infection (CDI)
- Catheter-Associated Urinary Tract Infection (CAUTI)
- Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia
Depending on the measures, hospitals that rank in the bottom quartile for HAC rates may be penalized by one percent of their annual Medicare payments. CMS set up the Hospital-Acquired Condition (HAC) Reduction Program as an incentive for hospitals to prioritize patient safety.
Criticism of the HAC Reduction Program by the Office of Inspector General
While the HAC reduction program intends to motivate hospitals to improve, the OIG assessment indicates that the program has only a minor impact. The initiative uses strictly specific lists of HACs and defined criteria for calculating harm events. Thus, they have limited effectiveness in encouraging patient safety more broadly.
Of all the harm events, the OIG discovered that the HAC Reduction Program only included five percent of the harm events. In other words, hospitals are not penalized for most hospital-acquired complications.
Furthermore, the OIG report discovered that a lower percentage (only two percent) of harm cases were included in the Deficit Reduction Act (DRA) HAC list. The Deficit Reduction Act aims to minimize additional payments for complications that are most likely to be avoided.
The OIG Recommendations to Improve the HAC Reduction Program
Despite the new patient safety incentives, there has been minimal progress toward improving patient safety over the last decade. Thus, the OIG has urged CMS and AHRQ to refocus on patient safety. Furthermore, the OIG compels these two federal agencies to implement new policies to reduce hospital-acquired harms and complications.
The recommendation by the OIG to the CMS and the AHRQ is for them to expand the HAC Reduction Program and DRA List. That is to broaden the types of harm and complications analyzed under the HAC Reduction Program and DRA List. The essence of this expansion is to capture common, preventable, and high-cost harm events.
Measures Currently Under Review For the HAC Reduction Program
CMS agreed with the OIG recommendation and is now considering the changes to the HAC Reduction Program through the yearly regulatory process for Medicare inpatient payments.
The Hospital Inpatient Quality Reporting (IQR) Program, which will begin in 2023, can also serve as an avenue for addressing the criteria. It will include two medication-related adverse-event electronic clinical quality measures (eCQMs) linked to glycemic management.
Furthermore, the following measures are currently under review for the HAC Reduction Program and the IQR Program:
- Severe obstetric complications
- Adverse opioid-related events
- The outcomes of hospital-onset bacteremia and fungemia
- Healthcare-related Clostridium Difficile Infection outcomes
Other Strategies To Reduce Medicare Patient Harm and Complication During Hospitalization
As the federal agencies strive to improve patient safety, hospitals, patients, and their loved ones are expected to do their part as well. Hospitals should implement routines like doctors and nurses washing their hands and confirming patient names before administering any medication.
Hospital employees must also feel free to speak up if they notice any problems with any patient. Not speaking up on time can cause further complications. Furthermore, patients and their families should feel comfortable expressing concern and making inquiries about nurses and doctors before admitting themselves or their loved ones to any hospital.
Patients and their families should inquire about medications, treatment plans, and staffing levels. Before admission, they should also research the patient safety ratings of the hospital on public websites such as CMS Hospital Compare or other private websites. Being confident and asking questions like these can go a long way toward preventing harm and complications during hospitalization.
Bottom Line
Improving the CMS HAC Reduction Program is one of the steps toward reducing in-hospital patient harm and complications. On the other hand, hospitals should also strive to elude preventable harms and complications as this will improve the safety of the patients and will also protect health practitioners from malpractice claims and CMS penalties.
