HACs Plummet 17%, Save $20B Under Obamacare

Data collected by the Agency for Healthcare Research and Quality shows that hospital-acquired conditions such as adverse drug events, pressure ulcers, and catheter-associated urinary tract infections declined sharply between 2010 and 2014.

Federal officials say safety and quality measures linked to the Patient Protection and Affordable Care Act resulted in 2.1 million fewer hospital-acquired conditions, saved 87,000 lives, and reduced healthcare costs by nearly $20 billion between 2010 and 2014.

"In 2014 alone we had 800,000 fewer patient harms, preventing nearly 37,000 deaths at hospitals and saved $6.8 billion for patients, families and the system," Patrick Conway, MD, principal deputy administrator/CMO at the Centers for Medicare & Medicaid Services, said during a conference call Tuesday.

"This is welcome news for patients and their families. These results represent real people who did not die or suffer infections or harm in the hospital."

Data collected by the Agency for Healthcare Research and Quality shows that HACs fell from 145 per 1,000 discharges in 2010 to 121 per 1,000 discharges in 2014, a 17% decline.

Hospital-acquired conditions include adverse drug events, catheter-associated urinary tract infections, central line associated bloodstream infections, pressure ulcers, and surgical site infections, among others. The Agency for Healthcare Research and Quality analyzed the numbers of avoidable HACs compared to 2010 rates using baseline estimates of deaths and excess healthcare costs developed by Partnership for Patients.

AHRQ Director Richard Kronick says the 37,000 lives saved from reduced HACs in 2014 were "approximately equivalent to a one-year hiatus from all deaths from breast cancer in the United States."

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The biggest reductions seen in the four-year span were among three of the most common HACs or adverse events, Kronick says. Adverse drugs events fell by 16% and contributed 40% of the overall reduction; pressure ulcers dropped 23% and represented 28% in the overall reduction; and catheter-associated urinary tract infections  (CAUTIs) dropped 38% and accounted for 16% of the overall reductions.

"Overall, other important hospital-acquired infections showed reductions in addition to the CAUTIs. Most notably there were very large reductions in central line-associated bloodstream infections, (CLASBIs)" Kronick says. "These infections are relatively rare, but quite deadly. In 2010, the rate of CLABSIs was 0.55 per 1,000 hospitalizations. By 2014 this rate was reduced by over 70% down to 0.15 per 1,000 hospitalizations. We are clearly not yet at zero but we are getting close."

Of the four most frequent HACs measured, falls was the only adverse event that did not improve over the four-year span.

"Falls are a double-edged sword," Kronick says. "Part of what's important for many patients is getting them up and about and having them move more, which increases their exposure to falls. A reasonable hypothesis might be that there are more patients moving more, which is a good thing, but also increasing exposures to falls, and that may be part of what is going on here."

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The report noted that after making considerable gains between 2010 and 2013, the improvements "held steady" between 2013 and 2014. Why that is so is not known. "We don't have a full answer to that question," Kronick says. "Part of the answer is that the dramatic improvements we saw in the earlier years were the relatively lower-hanging fruit and hospitals are now working on more difficult problems."

"Some of this is a timing issue," he says. "We adopted in 2014 the national action plan for adverse drug events modeled on the 2009 action plan to reduce healthcare-associated infections. That plan was just adopted in 2014 and it will be taking some time before we see the results of that and similarly a recent adoption of the national action plan for combatting antibiotic resistant bacteria. We need better evidence for reducing some kinds of harm as well as the continued effort from folks in hospitals around the country to try to figure this out."

While specific tactics are needed to combat specific HACs and adverse events, Conway says the safety and quality movement shares at least six common themes.

"One, it's important to have the evidence on how to improve patient safety," he says. "Two, we are seeing it is important to have a culture and a focus on patient harm across the board. You are not just working in one area. You are working in the whole culture and the whole system. Three, high-reliability methods that are really focusing on every single time delivering the right care. Four, data and transparency at a macro level for hospitals but also down to the unit level so they are able to drive improvement on that unit. Five, the right technical assistance and quality improvement support. Six is the right incentives. We are increasingly tying incentives to quality and safety results, and we're seeing when we do that combined with the previous items you move a national needle in patient harm in a way we have never seen before in this country's history."