By John Reichard, CQ HealthBeat Editor
April 12, 2011 -- A long line of health industry heavyweights flanked top Health and Human Services officials at the National Press Club this past week to launch what Centers for Medicare and Medicaid Services chief Donald M. Berwick has called the most ambitious national effort ever to reduce medical errors.
Berwick will need all the clout he can muster; he and other HHS officials are predicting a big payoff in lives and money saved from the initiative. Because the program is voluntary, making good on the projections is initially going to require a disciplined effort by hospital and other health care CEOs to devote time and resources to the project—in addition to their efforts to comply with the many requirements of the health care law.
"We're going to need will," Berwick said at the launch announcement. "We're going to need to decide to do this." But he also noted that the changes needed in health care delivery to meet the goals of the project will help hospitals qualify in a few years for incentive payments under the health law to improve patient safety.
Called the Partnership for Patients, HHS Secretary Kathleen Sebelius told reporters that over the next three years the program will help save 60,000 lives and has the potential to save up to $35 billion in medical costs, including as much as $10 billion in Medicare. Over the next ten years, the program could reduce costs to Medicare by about $50 billion and produce billions more in Medicaid savings, agency officials added.
HHS plans to spend up to $1 billion from the health overhaul law (PL 111-148, PL 111-152) to get the initiative off the ground. It has two objectives: decreasing preventable hospital-acquired conditions by 40 percent by the end of 2013 compared to 2010, as part of an effort to keep hospital patients from getting injured or sicker; and decreasing hospital readmissions by 20 percent over the same time period.
The initiative, which is designed to stop preventable injuries and complications in patient care, already has the backing of more than 500 hospitals, physicians and nurses groups, consumer organizations and employers, HHS officials said in releasing the details of the program.
Joining Berwick and Sebelius on the dais to announce the program were Cecil Wilson, president of the American Medical Association; Honeywell CEO David Cote; Gerry Shea, assistant to the president of the AFL-CIO; Oklahoma Medicaid Director Mike Fogarty, and Sorrel King, a patient advocate who said she lost her 18-month old to medical errors at the Johns Hopkins health system in Baltimore. Audience members included America's Health Insurance Plans President Karen Ignagni, Federation of American Hospitals President Chip Kahn, National Business Group of Health President Helen Darling, and representatives of other provider and consumer groups and the Department of Defense and VA health systems.
The Partnership will begin by asking hospitals to target nine types of medical errors and complications, including preventing adverse drug reactions preventing bed sores, childbirth complications and surgical site infections. The nine areas are ones in which hospitals have already demonstrated that dramatic reductions can be made in the rate of harm to patients.
Systems, not workers, to blame
Berwick emphasized that the problem isn't that health care workers are sloppy. "The workforce is not the problem," he said. "They want to offer safe care."
"Good people get trapped into bad systems," he said. The CMS head of the Centers for Medicare and Medicaid Services said that there are a variety of local health care systems that have made great strides in reducing medical errors. Other health care providers can learn from and adopt the processes of care involved and also make dramatic gains in preventing medical errors.
Reaching the goals may seem like a stretch given the fairly broad nature of the pledges participants in the program will make. For example, hospitals promising to take part must agree to make the goals of reducing harm and improving the transition of patients to care outside the hospital a priority for their board of directors, senior leaders, clinicians and staff. Clinicians will vow to "work to redesign activities across clinical settings to reduce harm" and learn from and share the experiences of others. Consumers groups pledge to educate patients and their families about steps they can take to assure that care is safer.
"This partnership is not about enforcement; it's about involvement," Berwick said in a brief interview after the press briefing. He noted that a voluntary effort is beginning to take shape in which CMS, along with private sector players, will make a variety of resources available to any hospital that wants to participate.
"You'll find easy access to support, you'll find peer and partners they can talk to ... they'll find tools for metrics. We'll be also be helping the local patients' groups" to strengthen the voice of the consumer, Berwick added.
"This is a period now, a window of voluntary engagement in really active improvement," Berwick observed. But under the health law, in 2013, 2014 and 2015 "there are real serious financial contingencies attached such that you'll see less and less paying for how much you do and more and more paying for how well you do."
"If your business plan at a hospital now is to take advantage of the idea that we're not going to not pay for how much you do, we're going to pay for how well you do, then you'd be very smart to be joining in this program because you're getting ready for that period when payment is for quality."
Asked why he's confident that hospitals will buy into this program, Berwick said "we have more knowledge now. It's not just saying please try harder, it's saying here's some things you really can do."
"What gives me most optimism is the response to this," Berwick said. "I'll tell you, we haven't made a phone call or an outreach to any stakeholder that hasn't said 'where do you need me, when can I show up.' Something feels different now, something feels like the tide is turning."
"We can over time eliminate just about every kind of patient injury," Berwick predicted.
Berwick's enthusiasm about patient safety partnerships was a hallmark of his efforts as head of the Boston-based Institute for Healthcare Improvement. He enlisted many hospitals in a campaign to adopt specific practices to reduce medical errors. The goal of 60,000 lives saved over three years is in addition to those earlier efforts, he said.
While the players in health care respond strongly to Berwick's passion for quality improvement, its actual impact remains to be seen—and given the specific goals outlined by the partnership—it will be measurable three years from now.
King, the opening speaker at the launch, said there is no time to waste. Her story suggested that fatal errors can befall anyone, even in the nation's finest health care systems.
"I'm here today because my daughter is one of the 98,000," she said. "It's time to come together…we've got to do it, and we've got to do it now. I have to tell you, it's not happening fast enough."
King said after the event that her daughter died because of communication failures that led the 18-month old to become dehydrated and to be given methadone when she shouldn't have been. Had either thing not occurred she would have survived, King said.
Noting the wide variety of groups that say they plan to participate in the patient safety program, Berwick said "I think we're there at last – where Sorrel asked us to be."
Brailer also credits Mostashari with having a gift for compromise, saying that rulemaking over what constitutes meaningful use of health IT has pitted those who wanted few demands on doctors against those who saw a rare opportunity to really push the medical profession hard to exploit its potential. Mostashari "was one of the key people that talked dreamers back into reality," Brailer said.
