Hospitals make progress in curbing harms to patients, but a lot more is needed

It’s hard not to look at the latest federal data on how hospitals have improved their efforts to avoid harming patients and think, “Pretty good job, folks. But can’t you do more?”

Yes, it does sound impressive that a big push under the Affordable Care Act, also known as Obamacare, has resulted in an estimated 87,000 fewer patients dying due to hospital-acquired conditions and that averting these harms saved $19.8 billion in costs  in the period between 2010 and 2014.

But it’s also true, as Kaiser Health News points out, that the measured successes also have hit a plateau after three years of declines in harms. As the KHN report notes, “Hospitals have averted many types of injuries where clear preventive steps have been identified, but they still struggle to avert complications with broader causes and less clear-cut solutions.”

And here’s where it gets unhappy, as KHN reports there still were:

“at least 4 million infections and other potentially avoidable injuries in hospitals last year. … That translates to about 12 of every 100 hospital stays. Among the most common complications that were measured — each occurring a quarter million times or more — were bed sores, falls, bad reactions to drugs used to treat diabetes, and kidney damage that develops after contrast dyes are injected through catheters to help radiologists take images of blood vessels.”

The Obama Administration has said that it will keep up the carrot-and-stick efforts to get hospitals to improve their performance through steady, consistent measurement and goal-setting, providing financial incentives to institutions that provide better care. Hospitals insist that they’re making progress and that the public will see even more as some of their initiatives kick in.

Still, as a recent Washington Post story found, patients and their families suffer enormously, in physical and fiscal pain, when medical errors occur and it remains all too often unclear that anyone will compensate them — in fact they may end up paying more for problematic care.

Unfortunately, as the Post points out, all too many American health care consumers fail to understand that malpractice lawsuits are expensive to pursue, and tort reform deliberately cuts down on how much the victim can claim, so as to make lawsuits, even meritorious ones, less financially viable for attorneys to take on contingency fee.

Further, many people confuse the reality of the current civil justice system, which is a negligence system not a no-fault compensation system. In our negligence system, plaintiffs must prove not just injury but that it should not have happened. Some patients may feel entitled to money just because they suffered an injury from medical care.

But that’s not the system we have — although ironically some tort reformers have proposed something like that. They do this to trivialize the whole enterprise so that it’s not about compensating people with horrific preventable injuries, but throwing small bones to everyone hurt, and then losing the moral aspect of the enterprise in the process.