Hospitals have cut down on deadly medical errors, saving around 87,000 lives since 2010, according to a new government report.
Pinning down the precise reasons for this change is difficult, to say nothing of predicting whether the decline will continue. Improvement has slowed in just the last year, the report suggests. But many analysts think government initiatives within the Affordable Care Act have played a significant role in the progress so far.
In short, Obamacare may literally be saving lives.
The new report comes from Agency for Healthcare Research and Quality, which is part of the Department of Health and Human Services and is something like an in-house think tank dedicated to making medical care safer and more effective. Since 2010, the agency has been tracking the incidence of common and frequently fatal medical errors, which include everything from a nurse accidentally giving a patient the wrong medication to a doctor inserting an intravenous line in a way that leads to a blood-borne infection.
On Tuesday, the agency announced its latest findings on these “hospital-acquired conditions,” based on preliminary data from 2014. For every 1,000 patients admitted to and then discharged from a hospital, the agency found, roughy 121 of them developed such a condition. That rate is unchanged from last year, but it is down 17 percent from 2010, when it was about 145 out of every 1,000 patients.
Based on the existing research about what happens to patients who get sick in the hospital and what it costs to treat them afterwards, that decline works out to roughly 87,000 lives saved and $19.8 billion not spent on extra medical care, according to the report.
"The progress is historic," David Blumenthal, president of the Commonwealth Fund, told The Huffington Post.
"We have never demonstrated a comparable decline in the history of the U.S. health system," added Blumenthal, a physician and researcher who also served in the Obama administration.
Broadly speaking, the progress is the result of a crusade that dates back at least to 1990s, when the Institute of Medicine released "To Err Is Human," a seminal report suggesting that nearly 100,000 people were dying each year because of preventable medical mistakes. Over time, researchers learned more about why these errors were so common and started developing methods for avoiding them. Probably the most famous of these was the introduction of checklists, like the ones that airplane pilots use before takeoff, for making surgery safer.
But getting hospitals to adopt these methods was difficult, despite the best efforts of some private-sector organizations, in part because existing financial incentives did not reward hospitals for improving quality. If anything, the opposite was true. Hospitals made money for every new treatment and a patient who got sick in the hospital needed more care, rather than less.
A major goal of the Affordable Care Act was to reduce and eventually eliminate these incentives for poor quality care, while rewarding the hospitals that getter better results. Today, for example, Medicare pays less to institutions with high rates of hospital-acquired infection, injury and readmission -- in other words, large numbers of patients returning to the hospital for treatment shortly after discharge. That's because of a series of penalties the health care law created in 2010, which started affecting hospital revenue three years later. And under an initiative called Partnership for Patients, the federal government provides extra funding to hospitals that agree to monitor patient safety and implement schemes for improving quality.
Experts can't be sure about the impact of these reforms, in part because previous studies showed that errors were declining even before 2010, albeit at a slower rate. And the new initiatives raise plenty of serious criticisms -- whether from hospital officials saying they are cumbersome to implement or from researchers who think the underlying data is unreliable.
But after the agency published last year’s results, showing the steep decline in errors, a wide array of experts said the law's new incentives were influencing hospital behavior -- and that, as a result, patients were getting better care. Lucian Leape, a professor at the Harvard School of Public Health and a pioneer in the patient safety movement, told Politifact, "I think these data reliable, and the ACA (Affordable Care Act) deserves credit."
The real cautionary note in Tuesday’s report may be what it says about the future. If this year’s preliminary data holds up, and the error rate for 2014 is truly no lower than it was for 2013, that would suggest progress had stalled -- with infections and injuries lower than before, but not as low as they could be.
"On the positive side, there has been no backsliding, so hospitals are, in the lingo of quality improvement, 'holding the gains,'" Blumenthal said. "But from the standpoint of public policy and given our obligation to eliminate preventable problems, we would should aim to see continued reductions in rates."
HHS officials on Tuesday offered similar thoughts. At a conference in Baltimore focusing on health care quality, an announcement of the new data drew large applause. But Patrick Conway, chief medical officer at the federal government’s Centers for Medicare and Medicaid Services, warned his audience not to be complacent. "The goal is to get to zero" errors, he said. "We’ve made significant progress. Now the question is how you accelerate that."
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