Opinion: Boosting safety may cut health care costs

A recent survey tells us that more than one-third of practicing physicians and 42 percent of the public report experiencing errors in the medical care that they or a family member received as a patient. Among those who experienced or witnessed a medical error, 18 percent of physicians and 24 percent of the public said that the mistake caused serious health consequences, resulting in disability, additional treatment or death. Improving patient care and safety while reducing medical errors will save lives and minimize resulting complications and unnecessary hospitalizations or procedures. The Institute of Medicine’s 1999 report, “To Err Is Human,” put the entire health care community on high-alert status. It told us that medical injuries account for between 48,000 and 98,000 deaths per year in the United States. Even at the lower number, medical errors are a leading cause of death in this country, ahead of breast cancer, AIDS or motor vehicle accidents.

Adding to the growing concern about patient safety, a 2002 report released by the U.S. Pharmacopoeia, a national standards-setting organization, said that while American hospitals and health systems are doing a better job of reporting medication errors, they continue to make the same mistakes repeatedly. Lapses in basic quality checks and ordinary standards of patient care led to most of the mishaps.

There has been plenty of finger-pointing and public outcry about health care costs, and there continues to be concern and debate about patient safety. What we overlook, however, is how intimately these two issues intertwine. A single, preventable adverse drug error in a teaching hospital costs more than $4,000. Washing hands alone could save an estimated 40,000 lives, cut infections in half and save up to $3.6 billion in costs. A serious injury can cost hundreds of thousands of dollars. Reducing injury rates by even 10 percent to 15 percent can yield large-scale savings. The Institute of Medicine estimates that medical errors cost the nation approximately $37.6 billion annually, with between $17 billion and $29 billion of those costs associated with preventable errors.

By implementing proven, accepted practices based on state-of-the-art scientific and medical evidence, we could save billions of health care dollars and redirect them toward making medical care more affordable for all Americans. There is no one solution to this massive, multifaceted problem. Solving it will require action by health plans, physicians, regulators and other stakeholders. Solutions lie in creating safer systems throughout the health care industry and in developing mechanisms that help consumers better navigate this complex system.

Part of the answer includes consumers taking charge of their own health. But more importantly, we need to focus on redesigning processes of care in hospitals and other care settings, and in tying payments by insurers to quality, rather than continuing our current medical reimbursement system that often pays for medical errors instead of preventing them. There continues to be a pattern of wide variation in health care practice, too. This should serve as a warning: We have not kept pace with the evolving science of health care to ensure evidence-based practice in the United States. As a safety measure, we need to demand that medicine be based on proven evidence and good science, not on marketing and unproven technologies.

Quality performance in the nation’s health care system must be enhanced, care must be patient-centered and costs associated with inefficient care eliminated. One role health plans can play today is to help reshape and improve health care systems through collaborative programs that engage network providers in the sharing of information to better manage chronic illnesses and in developing programs designed to increase patient safety.

A recent state-by-state sampling of treatment provided to Medicare patients tells us physicians are doing better than they did two years ago on 20 of 22 measures of quality. While the trend is in the right direction, the study did not state the reason for the improvement. However, these results follow an unprecedented effort by the federal government, health insurers, large corporations, unions and professional organizations to improve health care quality and patient safety, including incorporating evidenced-based care.

These types of applications are good for consumers, a hallmark of professionalism for physicians, and a springboard to a better, safer future in health care.

Dr. John Seidenfeld is vice president and medical director of Blue Cross Blue Shield of Missouri.