New system would encourage patients to report med errors to feds
Many skeptical about usefulness of such a program
A proposed system that would encourage patients to report medical errors is getting mixed reviews from the healthcare industry and legal professionals, with many expressing concern that the reports would yield little useful information but drive up medical malpractice costs.
The Agency for Healthcare Research and Quality (AHRQ) is proposing the new effort, which became public when The New York Times revealed it before the government had formally announced the plan. (The newspaper article is available online at http://tinyurl.com/patienterrors.)
A flier drafted for the project asks patients: “Have you recently experienced a medical mistake? Do you have concerns about the safety of your health care?” The flier goes on to urge patients to contact a new “consumer reporting system for patient safety. (See p. 135 for more on how the information is collected.)
The draft questionnaire also seeks to collect the name and address of the healthcare provider who made the mistake. The reports would be analyzed by researchers from the RAND Corp., a nonprofit institution that helps improve policy and decision-making through research and analysis, and the ECRI Institute, a nonprofit organization that investigates medical errors and evaluates medical devices.
The project could begin collecting information as soon as May 2013, according to the AHRQ. Reporting is voluntary, and federal officials said they would keep the information confidential.
Some healthcare leaders endorse the project, with Nancy E. Foster, a vice president of the American Hospital Association, releasing a statement saying, “The idea is welcome.” The American Medical Association issued a statement saying it is studying the proposal but does not yet have an opinion.
The proposed system might be well-intended but could be less useful than expected, says John D. Birkmeyer, MD, the George D. Zuidema Professor of Surgery with the University of Michigan Health Systems in Ann Arbor and director of the Center for Healthcare Outcomes & Policy at the University of Michigan. He has served in advisory roles with the Centers for Medicare and Medicaid Services (CMS), the American College of Surgeons National Surgical Quality Improvement Program, and the Leapfrog Group.
Birkmeyer believes a system for enabling patients to report medical errors may nudge provider accountability a little, but that data will be more noise than signal in reflecting the true quality, cost, and patient-centeredness of a given physician or hospital. It certainly won’t bring clinicians and patients closer together, he says, and it might do just the opposite.
“It’s hard to disagree with the basic concept, because accountability is what we all want in healthcare,” he says. “The only mechanism by which it could be a bad thing is if it is just a distraction from things that could really move the needle on hospital safety, or if there are unintended consequences like providing risk managers with unreliable information.”
One possible consequence, Birkmeyer says, is that healthcare providers will be less forthcoming about admitting errors to patients if they know that the patient might report that mistake to the database and possibly embellish or mischaracterize what happened.
“That flies in the face of the very strong momentum we have in the risk management world to encourage physicians to be more forthcoming about errors,” he says. “The idea of a national database gives physicians hives, so they can only be more reticent about volunteering information to the patient.”
The information in the database also could mislead, Birkmeyer says. Given the nature of how the information is reported, it is likely to be a weak indicator of the hospital’s or the physician’s quality, he notes. “Simply having a database of these error reports is not going to be useful unless you also account for factors like how many difficult, advanced procedures this facility or this physician performs,” Birkmeyer says. “This is the same problem we ran into years ago when there was a push for hospitals to report quality measures. A simple number of errors isn’t going to be useful by itself.”
The reports also are not likely to be accurate, says Adam Frederic Dorin, MD, MBA, founder and president of America’s Medical Society, a San Diego-based non-profit medical society that advocates for physician rights and patient safety. Collecting useful information on medical errors will be difficult when interviewing people who have little or no understanding of medical procedures or standards of care, he says.
The program could be overwhelmed with people who use it as a sort of complaint line about their healthcare providers, Dorin says. Even if the intent is more specific, chances are the public will see the program as an opportunity to vent about what they perceive as poor care, disrespect by providers, or other issues that do not concern actual errors. (See the story below for more questions about the program.)
“I think you’re going to have a fair number of people who just don’t know what they’re talking about, and then you’re going to have people who want to manipulate the system,” Dorin says. “The people who report that they got in an argument with the nurse but there really wasn’t any kind of error, how much is going to cost to ferret out those from the true reports of adverse events?”
Eight U.S. congressmen, seven of them physicians, wrote to Carolyn Clancy, MD, director of the Agency for Healthcare Research and Quality, to question how the information collected from patients would be used. (See the story on p.136 for more on their letter.)
Details of the program might be altered, but Birkmeyer says he expects the AHRQ will move forward with some version of a patient-reported error database.
“There is enough momentum in the system that I think it’s going to happen,” he says. “I suspect that its ultimate impact will be the collection of a lot of ad hoc data that doesn’t provide hospitals with any useful data to improve patient safety or patients with information that is really actionable. Then it will fade away from lack of impact.”
Sources
- Adam Frederic Dorin, MD, MBA, Founder and President, America’s Medical Society, San Diego. Telephone: (858) 344-0083. Email: [email protected].
- John D. Birkmeyer, MD, George D. Zuidema Professor of Surgery, University of Michigan Health Systems, Ann Arbor. Telephone: (734) 936-5738. Email: [email protected].
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