Health • State striving for greater disclosure of medical harms as its Medicaid program no longer pays to treat injuries caused by poor care.
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Utah's Medicaid program no longer pays hospitals to treat illnesses and injuries caused by poor care for patients, such as infections, on-site falls and surgeries on the wrong body part.
Hospitals have had to report these "provider-preventable conditions" to the Utah Department of Health since July 2011, a requirement of federal health reform. They've disclosed 17 to date, most of them infections.
But precisely how much taxpayer money was saved isn't known. "Because costs for the same procedure can vary, it would be impossible to provide an estimate for claims that can't, haven't and won't be reimbursed," said health department spokeswoman Kolbi Young.
And if consumers are curious to know where these most serious of medical errors are happening, they're out of luck. Names of reporting hospitals are kept confidential and reporting is spotty.
"This is a very new data collection process and not everybody has been reporting. It's a work-in-process kind of thing," said Rod Betit, executive director of the Utah Hospital Association. "We had to agree upon which events to report, and how to define them. We need to have a baseline before releasing information showing what progress is being made, or not being made, at various facilities."
Reporting is quasi-mandatory. Providers caught shirking the requirement might no longer be paid for treating Medicaid patients, but would suffer no other penalties. The same rules apply to providers who take Medicare.
'Why are we not paying attention?' • It has been more than a decade since a panel of top scientists set a national goal of improving hospital safety. Yet medical harms remain a leading cause of death.
Hospital-acquired infections alone kill 90,000 people a year in the U.S. They increase the length of hospital stays and cost $6 billion annually, according to the Centers for Disease Control.
"If you took that rate of injury and superimposed it on the American airline industry, you'd have a fully loaded plane going down, killing everyone aboard, every week," said Joe Jarvis, a semi-retired Utah doctor and long-time advocate for mandatory reporting. "Why are we not paying attention to this?"
Utah has made strides in requiring greater public disclosure of "sentinel events," mistakes that result in unexpected death or a serious physical or psychological injury.
Hospital-by-hospital results are kept confidential out of fear that it could have a chilling effect on reporting.
Indeed, reporting has improved. And as a result, errors have spiked, peaking at 95 sentinel events in 2009, a recent Health Department report shows. They've leveled off since then; there were 81 reported in 2011.
Taking cues from states that are moving toward greater transparency, Utah last year passed a law that asks health systems to publish their hospital-acquired infection rates on their websites and on a state web portal. Reporting starts in May. Unlike dozens of states with similar laws, it's voluntary.
But sponsoring Rep. Jack Draxler, R-Logan, trusts that hospitals, in the spirit of competition, will comply.
"It took an extraordinary amount of discussion with hospitals, infection control officers and patient advocates," Draxler said. "I wish the pace were faster but I think we'll have more meaningful data than we have had in the past."
The U.S. government also publishes infection rates, but as averages. Draxler wants consumers to be able to compare hospitals on a state website.
"If you're going in for a hip replacement you'll be able to pick those hospitals with the lowest infection rates," he said.
Data gaps • Until then, what's not being reported, and by whom, isn't immediately clear even among Medicaid providers.
State health officials cull their sentinel reports from a database of hospital discharges. A review by The Salt Lake Tribune of that data more than 250,000 discharges in 2009 confirms Medicaid errors are under-reported.
Most of the major hospitals that year reported instances of retained surgical equipment, typically sponges used to control bleeding. Together they claimed 29 such cases. Of those, three, or 10 percent, involved Medicaid patients.
But Medicaid has no record of such errors in 2010.
"You could assume that in a given year 10 percent of retained foreign objects will affect Medicaid," said Iona Thraen, state patient safety director. "But doing so doesn't tell you if the problem was the hospital's fault. In other words, was the problem present on admission or was it the result of care elsewhere?"
Starting this year, all hospitals not just those that treat Medicaid patients must add a "present on admission" code to discharge records.
Until that information is publicly available, a hospital could be having a problem with infections and no one would ever know, Jarvis said. "I think Utah is better than most states given the quality of care here. But I have no data to prove that."
Thraen isn't convinced it's fair or even meaningful to compare hospitals for mistakes as rare as retained surgical objects.
"There are so few of these events that one facility could have the highest number one year and lowest number the next. These are spikes in egregious errors that get lots of attention, but they're rare," she said. "Looking at something like flu vaccination rates of employees makes more sense for consumers."
Utah's medical errors, 2011
Utah health care providers reported these medical mistakes last year:
6 Urinary tract infections
1 Complications from poor blood sugar control in diabetic patients
1 Surgical site infection
5 Vascular catheter-associated infections
Errors that Medicaid providers must report:
Sponges and surgical equipment left inside a patient after surgery
Air bubbles trapped in blood vessels
Wrong blood type given during transfusions
On-site falls and injuries
Catheter-associated urinary-tract infections
Vascular catheter infections
Life-threatening complications stemming from failure to keep diabetic patients' blood sugar under control
Surgical site infection following heart bypass surgery, weight loss surgery and orthopedic procedures
Blood clot inside a vessel or the lungs following a total knee or hip replacement
Surgery on the wrong body part
Surgery on the wrong patient
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