Quarter of Hospitalized Medicare Patients Experienced Harm in October 2018

The findings of the inspector general study are similar to Medicare data reported in 2010.

Medicare patients experience harm in hospitals at a relatively high rate and the harm costs the federal program hundreds of millions of dollars per month, according to a new report from the U.S. Department of Health and Human Services Office of Inspector General (OIG).

In 2010, OIG published the first report on Medicare patient harm in hospitals, finding that 27% of patients experienced harm in October 2008. These harm events cost Medicare and patients an estimated $324 million in reimbursement, coinsurance, and deductible payments. Nearly half of the harm events were deemed preventable.

The new report is based on a review of medical records for a random sample of 770 Medicare patients who were discharged from hospitals in October 2018. Patients experience two kinds of harm. "Adverse events" resulted in longer hospital stays, permanent harm, life-saving intervention, or death. "Temporary harm events" resulted in interventions, but they did not cause lasting harm, prolong hospital stays, or require life-sustaining measures.

The report features several key findings.

• In October 2018, 25% of Medicare patients experienced adverse events (12% of patients) or temporary harm events (13% of patients).
   
• Reviews by physicians found that 43% of the harm events could have been avoided with better care.
   
• The most common harm events were linked to medication (43%), followed by patient care such as pressure injuries (23%), procedures and surgeries (22%), and infections (11%).
   
• Among patients who experienced a harm event, 23% required treatment that resulted in additional Medicare costs. These costs were variable and there was a small sample of patients, so OIG was not able to estimate the costs with precision. The costs of patient harm events in October 2018 range from $347 million to $1.2 billion.
   
• The Centers for Medicare & Medicaid Services (CMS) have two programs that reduce reimbursement to hospitals for some hospital-acquired conditions (HACs): the HAC Reduction Program and the Deficit Reduction Act HAC list. For the harm events that the OIG found, only 5% were on the HAC Reduction Program list and only 2% were on the Deficit Reduction Act HAC list.

In comparing the first OIG report in 2010 with the new report, there has been little change in harm events for hospitalized Medicare patients, the new report says. "Our findings suggest that patient harm events continue to be widespread among Medicare patients in hospitals since the publication of our 2010 report, with an estimated 27% of Medicare patients experiencing harm in 2008 and an estimated 25% of Medicare patients experiencing harm in 2018. … When comparing the results, we did not detect a statistically significant difference in the rates of patient harm, severity of harm events, or preventability of harm events over time."

Recommendations to improve safety

The new report issues seven recommendations to improve safety for hospitalized patients.

Three recommendations are made to CMS: "(1) update and broaden its lists of [hospital-acquired conditions] to capture common, preventable, and high-cost harm events; (2) explore expanding the use of patient safety metrics in pilots and demonstrations for healthcare payment and service delivery, as appropriate; and (3) develop and release interpretive guidance to surveyors for assessing hospital compliance with requirements to track and monitor patient harm."

Four recommendations are made to the Agency for Healthcare Research and Quality: "(1) with support from HHS leadership, coordinate agency efforts to update agency-specific Quality Strategic Plans; (2) optimize use of the Quality and Safety Review System, including assessing the feasibility of automating data capture for national measurement and to facilitate local use; (3) develop an effective model to disseminate information on national clinical practice guidelines or best practices to improve patient safety; and (4) continue efforts to identify and develop new strategies to prevent common patient harm events in hospitals."

Related: The Leapfrog Group: 33% of U.S. Hospitals Earn "A" Grade for Patient Safety