Medicare Costs Higher Among Hospitals With High Rates of Adverse Safety Events

AHRQ Stats

Access more data on this topic in the associated Statistical Brief.

Today's Headlines:

• Medicare Costs Higher Among Hospitals With High Rates of Adverse Safety Events.
• Issue Brief Urges Strategic Focus To Advance Diagnostic Safety Measurement.
• Out-of-Network Care Associated With Higher Spending in Medicare ACOs.
• PSNet Perspective Highlights Role of Medical, Nursing Education in Improving Patient Safety.
• Highlights From AHRQ’s Patient Safety Network.
• Now Updated: Federal Compendium of Health Datasets.
• AHRQ in the Professional Literature.

Medicare Costs Higher Among Hospitals With High Rates of Adverse Safety Events

Hospitals with higher than average rates of adverse events, such as falls or medication events, are more likely to have higher costs for treatment of certain cardiac conditions and pneumonia, according to an AHRQ-funded study published in JAMA Network Open. The study examined 2011-2016 Medicare data from about 2,200 hospitals and nearly 45,000 patients with conditions common among older adults. Every 1 percent increase in hospitals’ adverse event rates was associated with an average cost increase of $103 for heart attack, $100 for heart failure and $152 for pneumonia per discharge, for all discharges in these three patient groups. For example, for every 1,000 heart attack patients in the higher adverse event rate hospitals, the average cost increase would be approximately $103,000. Authors said the findings support assumptions that higher adverse event rates add costs to patient care and may reflect the quality of hospital care, and that investment in reducing adverse events may provide substantial savings in Medicare costs. Access the abstract.

Issue Brief Urges Strategic Focus To Advance Diagnostic Safety Measurement

Although few healthcare organizations have implemented systematic measurement of diagnostic errors, nearly all can use existing resources to strategically monitor diagnostic safety for learning and improvement, according to a new AHRQ-funded issue brief. Diagnostic errors affect approximately 1 in 20 U.S. adults each year, and reducing their incidence is an AHRQ priority. Healthcare organizations can begin to measure diagnostic performance by creating learning opportunities from past events with potential and real harm and by proactively monitoring for high-risk conditions, according to the authors. The issue brief includes a “call to action” for healthcare organizations to begin measurement efforts using data sources currently available to them to identify and learn from diagnostic errors. Access the issue brief, Operational Measurement of Diagnostic Safety: State of the Science.

Out-of-Network Care Associated With Higher Spending in Medicare ACOs

Substantial program savings could be achieved if seniors enrolled in Medicare accountable care organizations (ACOs) were encouraged to obtain primary care services within the ACO network, according to an AHRQ-funded study published in Health Affairs. This study examined the association between out-of-network care among Medicare ACO patients and per-patient spending. Using Medicare data from 2012 to 2015, researchers found that for each percentage-point increase in out-of-network primary care, there was a $10.79 increase per patient in quarterly total ACO spending. Out-of-network primary care was associated with higher spending in outpatient, skilled nursing facility and emergency department settings, but not inpatient settings. Researchers suggested lowered copayments as one way to encourage obtaining primary care services within the Medicare ACO network. Access the abstract.

PSNet Perspective Highlights Role of Medical, Nursing Education in Improving Patient Safety

Medical, nursing and other clinical education can make strong contributions to patient safety with relevant curricula and effective teaching methods, according to an annual Perspective on Safety from AHRQ’s Patient Safety Network (PSNet). The authors describe major themes and developments in medical and nursing education that are enhancing patient safety, including understanding common causes of errors and how to avoid them, as well as adopting teamwork behaviors. In addition to summarizing patient safety curricula and teaching methods, the perspective highlights major resources, research and reports published in 2019. Access the perspective. 

Highlights From AHRQ’s Patient Safety Network

AHRQ’s Patient Safety Network (PSNet) highlights journal articles, books and tools related to patient safety. Articles featured this week include:

• Opioid prescribing patterns among medical providers in the United States, 2003-17: retrospective, observational study.
• Misdiagnosis, mistreatment, and harm - when medical care ignores social forces.
• Hierarchy and medical error: speaking up when witnessing an error.
• Using Safety-II and resilient healthcare principles to learn from Never Events.

Review additional new publications in PSNet’s current issue or access recent cases and commentaries in AHRQ’s WebM&M (Morbidity and Mortality Rounds on the Web).

Now Updated: Federal Compendium of Health Datasets

AHRQ has joined other federal partners as contributors to an updated Department of Health and Human Services (HHS) Compendium of Federal Datasets Addressing Health Disparities (PDF). The Compendium was produced by the Interdepartmental Health Equity Collaborative and is hosted by the HHS Office of Minority Health. First released in 2016, the Data Compendium identifies the relationship among socioeconomic factors, social determinants of health and health equity. The updated Compendium includes descriptions of more than 250 databases, information relevant to public health crises and information on datasets with more controlled access. AHRQ’s contributions to the Compendium include:

• Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plan Survey.
• Consumer Assessment of Healthcare Providers and Systems (CAHPS) Clinician and Group Survey.
• Healthcare Cost and Utilization Project (HCUP).
• Medical Expenditure Panel Survey (MEPS).
• National Healthcare Quality and Disparities Report (NHQDR).

AHRQ also publishes Data Spotlights, which each month focus on special measures drawn from the NHQDR.

AHRQ in the Professional Literature

Impact of timing on measurement of decision quality and shared decision making: longitudinal cohort study of breast cancer patients. Sepucha KR, Langford AT, Belkora JK, et al. Med Decis Making 2019 Aug;39(6):642-50. Epub 2019 Jul 29. Access the abstract on PubMed®.

Potentially avoidable inter-facility transfer from Veterans Health Administration emergency departments: a cohort study. Mohr NM, Wu C, Ward MJ, et al. BMC Health Serv Res 2020 Feb 12;20(1):110. Access the abstract on PubMed®.

EHR audit logs: a new goldmine for health services research? Adler-Milstein J, Adelman JS, Tai-Seale M, et al. J Biomed Inform 2020 Jan;101:103343. Epub 2019 Dec 7. Access the abstract on PubMed®.

A methodology for studying organizational performance: a multistate survey of front-line providers. Lasater KB, Jarrin OF, Aiken LH, et al. Med Care 2019 Sep;57(9):742-9. Access the abstract on PubMed®.

Association of home noninvasive positive pressure ventilation with clinical outcomes in chronic obstructive pulmonary disease: a systematic review and meta-analysis. Wilson ME, Dobler CC, Morrow AS, et al. JAMA 2020 Feb 4;323(5):455-65. Access the abstract on PubMed®.

Changes in hospital service demand, cost, and patient illness severity following health reform. Pickens G, Karaca Z, Gibson TB, et al. Health Serv Res 2019 Aug;54(4):739-51. Epub 2019 May 9. Access the abstract on PubMed®.

Novel risk factors for central-line associated bloodstream infections in critically ill children. Woods-Hill CZ, Srinivasan L, Schriver E, et al. Infect Control Hosp Epidemiol 2020 Jan;41(1):67-72. Epub 2019 Nov 5. Access the abstract on PubMed®.

Physician perspectives on deprescribing cardiovascular medications for older adults. Goyal P, Anderson TS, Bernacki GM, et al. J Am Geriatr Soc 2020 Jan;68(1):78-86. Epub 2019 Sep 11. Access the abstract on PubMed®.