Welcome to Health Reform Watch, Jason Millman's regular look at how the Affordable Care Act is changing the American health-care system — and being changed by it. You can reach Jason with questions, comments and suggestions here. Check back every Monday, Wednesday and Friday afternoon for the latest edition, or sign up here to receive it straight from your inbox. Read previous columns here.
People are human, hospitals are staffed by humans, so it's no surprise that mistakes happen in hospitals. But it looks like hospitals are getting better at cutting down on their own errors.
The rate of hospital-acquired conditions — complications that develop during a patient's stay — dropped nine percent between 2010 and 2012, according to new data from the Department of Health and Human Services. That translates to 15,000 fewer deaths in hospitals, a $4.1 billion savings in avoidable costs and a total of 560,000 "patient harms" avoided in 2011 and 2012, HHS says. For reference, a Journal of Patient Safety study last year estimated anywhere between 210,000 and 400,000 hospital deaths tied to preventable harm each year.
The biggest hospital improvements appear to be in early elective births, which are down 64.5 percent from the 2010 baseline through the fourth quarter of 2013. HHS also counts reductions in hospital-acquired pneumonia (53.2 percent), pressure ulcers (25.2 percent), obstetric trauma rate (15.8 percent), falls and trauma (14.7 percent) and venous thromboembolic complications (12.9 percent).
It also looks like hospitals are doing a better job of keeping patients away after they've been discharged. The 30-day hospital readmission rate for seniors in the traditional Medicare program — a measure of how many of those patients return to a hospital after an initial visit — held steady at 19.5 percent between 2007 and 2011, and then fell to 18.5 percent in 2012 and 17.5 percent in 2013, HHS said. That adds up to 150,000 fewer hospital readmissions between 2012 and 2013 for traditional Medicare beneficiaries.
The department partially attributed the decrease to Affordable Care Act programs, one of which penalizes hospitals for high readmission rates and another which rewards hospitals for quality care. The readmission penalties alone hit 2,225 hospitals last year. These programs, which took effect in October 2012, are still new, and the industry is still working through how the incentive structures could be better targeted.
Still, it's a notable effort to root out waste in Medicare and the health-care system. The Centers for Medicare and Medicaid Services has previously said that the Medicare program pays $26 billion each year for hospital readmission, including $17 billion for return trips that could have been avoided if proper care was provided the first time.
And this is also obviously good news for patients, who generally aren't eager to make return trips to the hospital.
Top health policy reads from around the Web.
Companies want to weed out sick employees. "Can corporations shift workers with high medical costs from the company health plan into online insurance exchanges created by the Affordable Care Act? Some employers are considering it, say benefits consultants. ... And the health law might not prohibit it, opening a door to potential erosion of employer-based coverage." Jay Hancock in Kaiser Health News.
Can we finally move past the whole "death panel" thing? "If you are one of the estimated 70 percent of Americans who have not documented your end-of-life healthcare preferences, Republican Senator Tom Coburn of Oklahoma hopes a cash incentive will prompt you to do the paperwork. Under his newly introduced Medicare Choices Empowerment and Protection Act, seniors could pocket up to $75 for completing advance directives. Directives are written instructions in which people specify what healthcare actions should be taken if they cannot speak for themselves." Randi Belisomo in Reuters.
The District has a funding plan for its exchange. "The D.C. Council on Tuesday unanimously approved a broad tax on all health-related insurance products sold in the nation’s capital to solve a big money problem faced by its online health insurance exchange. Under the measure, which will take effect on an emergency basis but eventually face congressional review, the exchange will fund its operating costs through a 1 percent tax on more than $250 million in insurance premiums paid annually by those who live and work in the District." Aaron C. Davis in The Washington Post.