Calif. warns hospitals to boost quality, safety of care or get booted from ACA

coveredcalif-300x169Although Republicans have ripped at the health insurance offered under the Affordable Care Act, a less known but also important aspect of Obamacare may soon benefit Californians. This West Coast ACA-related move also may be worth watching by patients and medical safety advocates, as well as employers and insurers.

The Golden State, the San Francisco public radio station KQED reported, soon will tell hospitals that “time’s up” for them to improve their care, and, if they fail to hit new quality and safety targets that will be part of an impending three-year contract with Covered California, the ACA marketplace operator, they will get the boot from Obamacare coverage.

Because bluer-than-blue Democratic California has gone all-in in supporting and putting ACA coverages in place, the state’s Obamacare exchange is big (more than 1 million customers and 11 approved companies) and lucrative — so much so hospitals and insurers can’t ignore the quality demands. They’re neither extreme nor should they be surprising, because state officials emphasize they have consulted with key parties for several years now in the “Smart Care California” collaborative about the plans they intend to put in place.

As KQED reported:

The chosen targets require hospitals to perform fewer unnecessary C-sections, prescribe fewer opioids, and cut back on the use of imaging (X-rays, MRIs, and CT scans) to diagnose and treat back pain – procedures and technologies that have been overused to the point of causing patient harm.

These measures will be key, for example, because caesarean sections may be “medically prudent when the mother or fetus has a high risk of complication,” but as KQED also reported:

[M]any women who don’t need a C-section often get one anyway. Even in low-risk cases, some California hospitals are delivering 70 percent of those babies by C-section. [And] unnecessary C-sections create unnecessary risks: infection, hemorrhage, even death. Babies delivered by C-section are more likely to have complications and spend more time in the neonatal intensive care unit.

Officials in Massachusetts, New York, and Connecticut are reportedly eyeing the California plans closely.  Leah Binder, CEO of the Leapfrog Group, a Washington, D.C.-based nonprofit that rates hospitals on quality, called the California move, “probably the boldest move we’ve seen in maternity care ever,” adding the overall effort will be key, because, “Back in the ’80s and ’90s, nobody ever thought that hospitals should have to report to anyone on how they were doing. There’s never been a culture of accountability.”

In my practice, I see the major harms that patients can suffer while seeking medical care, and I’ve watched for some time now, wondering when and what it might take to get hospitals with the program to reduce damage they inflict on already sick people in their trusted care. Despite lawsuits, regulator crack downs, and well-intended campaigns by institutions themselves, hospitals continue to pose unacceptable risks to patients.

While progress has been made, the federal Centers for Disease Control and Prevention reported in 2011 that more than 700,000 Americans suffered hospital acquired infections and this alone led to 75,000 deaths. These preventable sicknesses are part of the significant bane of medical errors, which claim the lives of roughly 685 Americans per day─ more people than die of respiratory disease, accidents, stroke and Alzheimer’s. Medical errors, experts say, may now be the third leading cause of death in the U.S., behind only heart disease and cancer.

Doctors and hospitals have got a long way to go to ensure that patients leave medical facilities healthier than when admitted — well and alive — and we need to employ every measure we can to accomplish this. Let’s see what big and path-breaking California adds. We should all watch with our fingers crossed

Patrick Malone & Associates, P.C. listed in Best Lawyers Rated by Super Lawyers Patrick A. Malone
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