Public Citizen is proposing ten 10 cost-cutting, patient safety measures that it contends would save an estimated 85,000 lives and $35 billion a year. The report, "Back to Basics," analyzed the results of scientific studies of treatment protocols for chronically recurring, avoidable medical errors.
In contrast to the high-tech tests and procedures that many experts blame for staggering increases in the nation's health care costs, most of the reforms in Public Citizen's report involve fundamentals as simple as practitioners consistently washing their hands, sufficiently tending to patients to prevent bed sores, and following simple safety checklists to prevent infections and complications stemming from operations.
Aside from the tragedy of needless deaths and injuries, the financial toll of failing to follow accepted safety procedures is astounding. Severe pressure ulcers cost an average of $70,000 apiece to treat. A catheter infection costs $45,000. Each instance of ventilator-associated pneumonia costs $5,800. Collectively, avoidable surgical errors cost an estimated $20 billion a year, bed sores $11 billion and preventable adverse drug reactions $3.5 billion.
"There are many incentives to order expensive tests and procedures and too few rewards for providing basic, sensible care," said David Arkush, director of Public Citizen's Congress Watch division. "As the largest investor in the nation's health care system, the federal government should ensure that fulfilling basic patient safety standards is a condition of receiving federal reimbursements. And the government should pay providers for doing the right thing. It will save money in the long run."
Public Citizen proposes that health care providers:
• Use a checklist to reduce avoidable deaths and injuries resulting from surgical procedures (saves $20 billion a year);
• Use best practices to prevent ventilator-associated pneumonia (saves 32,000 lives and $900 million a year);
• Use best practices to prevent pressure ulcers (saves 14,071 lives and $5.5 billion a year);
• Implement safeguards and quality control measures to reduce medication errors (saves 4,620 lives and $2.3 billion a year);
• Use best practices to prevent patient falls in health care facilities (saves $1.5 billion a year);
• Use a checklist to prevent catheter infections (saves 15,680 lives and $1.3 billion a year);
• Modestly improve nurse staffing ratios (saves 5,000 lives and $242 million a year);
• Permit standing orders to increase flu and pneumococcal vaccinations in the elderly (saves 9,250 lives and $545 million a year);
• Use beta-blockers after heart attacks (saves 3,600 lives and $900,000 a year); and
• Increase use of advanced care planning (saves $3.2 billion a year).
Public Citizen also proposes five steps to ensure near-universal adoption of these changes:
• The federal government should use its enormous leverage from its $750 billion annual investment in health care to compel providers to use proven patient safety practices. The Department of Health and Human Services (HHS) has the authority to enact many of reforms proposed in Public Citizen's report through the regulatory process. Congress could ensure rapid adoption by including instructions to HHS in legislation;
• Congress should require HHS to take responsibility for accrediting providers to receive Medicare reimbursements. At present, the federal government delegates most accrediting authority to the Joint Commission, a private entity that derives its income from the very hospitals it oversees and denies accreditation to less than one percent of these hospitals;
• Congress should make significant financial investments to increase the country's supply of nurses and set federal minimums of acceptable nurse-to-patient ratios. Nurse shortages are often implicated in patient safety errors. Modest increases would yield significant improvements. A significant increase in the number of nurses could produce dramatic results. One study estimated that increasing the number of nurses by a little more than one-third would save an astounding 72,000 lives annually;
• Congress should require mandatory reporting of adverse events, including requiring hospitals to institute strong internal reporting systems, and creating whistle-blower protections for health care workers. National reporting of the most serious medical errors is largely left to the Joint Commission. However, that organization estimates that it learns of only about one-tenth of 1 percent of serious medical errors despite its stated requirement that doctors disclose all errors to patients. In 1996, the Joint Commission contemplated requiring mandatory reporting but succumbed to industry pressure and settled for voluntary reporting; and
• Congress should ensure that the requirements for hospitals to report doctor discipline and maintain viable peer review processes are followed. Hospitals have been required since 1990 to report to the federal government cases in which doctors are suspended for more than 30 days. But nearly 50 percent of hospitals have never reported a single disciplinary action. This may be due to hospitals flouting the law, evading the spirit of the law by customizing penalties to sail below the reporting threshold, or failing to carry out warranted doctor discipline altogether because of inadequate peer review processes.