Measuring the ROI in Patient Safety Reporting · Measuring the ROI in Patient Safety Reporting...
Transcript of Measuring the ROI in Patient Safety Reporting · Measuring the ROI in Patient Safety Reporting...
Measuring the ROI in Patient Safety
Reporting
Measuring the ROI in Patient Safety
Reporting
Donna Scott, RN, BSN, MBA, CPHQ, LHRMDonna Scott, RN, BSN, MBA, CPHQ, LHRM
What is a Medical Error?What is a Medical Error?
• Adverse or Sentinel Event• Near Miss or Close Call• Adverse or Sentinel Event• Near Miss or Close Call
What Do We Know about Medical Errors?
What Do We Know about Medical Errors?
• A leading cause of death• More common than we thought• Preventable• More surgical than medication-based • A system problem• Costly• A greater awareness by the public
• A leading cause of death• More common than we thought• Preventable• More surgical than medication-based • A system problem• Costly• A greater awareness by the public
• 44,000 to 98,000 deaths per year• $37.6B in costs per year*• Preventable mistakes cost $17 to $29 billion per year*• Medical errors consume 10-15% of a hospital’s annual
operating budget
• 44,000 to 98,000 deaths per year• $37.6B in costs per year*• Preventable mistakes cost $17 to $29 billion per year*• Medical errors consume 10-15% of a hospital’s annual
operating budget
70% of Medical Errors are Preventable
Potentially Preventable
Unpreventable
70%
24%
6%
70%
24%
6%
PreventablePreventable0
100000
200000
300000
400000
500000
600000
700000
800000
Ann
ual D
eath
s
Heart Disease
Cancer
Stroke
Lung Disease
Medical Erro
rs
Diabetes
Pneumonia
Alzhemer'
s
Kidney Disease
Medical Errors are a Leading Cause of
Death
*IOM Report 1999
The Patient Safety CrisisThe Patient Safety Crisis
$0
$10,000
$20,000$30,000
$40,000
$50,000
$60,000
BloodInfection
Hospitalacquiredinfection
FailedIncision
Pneumonia ADE
Event Cost of Common Preventable Errors
*Brigham and Woman's Hospital** The Pennsylvania Health Care Cost Containment Council, 2005***1.6 Million Admission Analysis, MedMined, Inc. September 2006
•• Preventable Medication Errors Preventable Medication Errors –– Occur in 2% of admissions*Occur in 2% of admissions*–– Increase hospital cost by $4,700 per admission Increase hospital cost by $4,700 per admission –– Cost providers $2 billion annuallyCost providers $2 billion annually
•• Preventable Hospital Acquired Infections **Preventable Hospital Acquired Infections **–– 7.5 per 1000 admissions7.5 per 1000 admissions–– 15.4% or 1,793 of these patients die15.4% or 1,793 of these patients die–– Additional 205,000 days of careAdditional 205,000 days of care–– $2 billion in additional charges to payers$2 billion in additional charges to payers
The Patient Safety CrisisThe Patient Safety Crisis***1 in every 20 hospitalized patients acquire infections
Greater than 50% of the $17 - $29 billion national cost associated with medical errors is preventable.
Source: Thomas EJ, Studdert DM, Newhouse JP et al. 1999. Costs of medical injuries in Utah
and Colorado. Inquiry. 36:255-64.
Greater than 50% of the $17 - $29 billion national cost associated with medical errors is preventable.
Source: Thomas EJ, Studdert DM, Newhouse JP et al. 1999. Costs of medical injuries in Utah
and Colorado. Inquiry. 36:255-64.
Major OpportunityMajor Opportunity
When is Good Performance Good Enough?
When is Good Performance Good Enough?
• If we were 99.99% accurate, we would still experience: – 2 unsafe plane landings per day at O’Hare
Airport – 500 incorrect surgical operations each week– 50 newborns dropped at birth by doctors
daily – 32,000 missed heartbeats per person, per
year – 200,000 documents lost by the IRS this year
• If we were 99.99% accurate, we would still experience: – 2 unsafe plane landings per day at O’Hare
Airport– 500 incorrect surgical operations each week– 50 newborns dropped at birth by doctors
daily– 32,000 missed heartbeats per person, per
year– 200,000 documents lost by the IRS this year
1 Significant29 Minor/Major
300 Near Miss/No Harm**Heinrich Ratio
• 1:28:30 – Prior to implementation• 1:26:100 – Year 2• 1:29:150 – Year 3• 1:30:500 – Year 5• 1:30:1500 – Year 8
• 1:28:30 – Prior to implementation• 1:26:100 – Year 2• 1:29:150 – Year 3• 1:30:500 – Year 5• 1:30:1500 – Year 8
Harm Ratio Evolution in Study Site Harm Ratio Evolution in Study Site
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Event Report Rate Per 1,000 Adjusted Admissions
Event Report Rate Per 1,000 Adjusted Admissions
Measurement ApproachMeasurement Approach
• “The more information you flush out, the more you learn about the vulnerabilities in your system”
• Martin J. Hatlie, JD, founding Executive Director, National Patient Safety Foundation
• “The more information you flush out, the more you learn about the vulnerabilities in your system”
• Martin J. Hatlie, JD, founding Executive Director, National Patient Safety Foundation
ROI Initial Study MethodsROI Initial Study Methods• Total cost of care for (DRG, severity adjusted)
patients with error/event less total costs care for all patients in same DRGs.
• May under estimate reductions since reference group includes all patients --- those with and without a medical error/event.
• Algorithm built within a reporting software system
• Total cost of care for (DRG, severity adjusted) patients with error/event less total costs care for all patients in same DRGs.
• May under estimate reductions since reference group includes all patients --- those with and without a medical error/event.
• Algorithm built within a reporting software system
Improvement AreaImprovement AreaNumber of Number of Reported Reported
EventsEvents
Average Average Additional Additional
LOSLOSAdditional Additional Cost/EventCost/Event
Annual Annual Additional Additional
CostCost
Medication Errors 865/ year 1.8 days $1,022 $510,824
Patient Falls 610 / year 2.2 days $889 $484,816
Pressure Ulcers (Stages I – IV) 399 / year 4.63 days $2,644 $628,962
Hospital-Acquired Infections 381/ year 4.06 days $2,723 $936,671
Total Identified Cost Savings OpportunityTotal Identified Cost Savings Opportunity $2,561,273$2,561,273
*450 Bed Community Hospital
ROI Analysis FindingsROI Analysis Findings3 Year Study3 Year Study
ROI Initial Study ResultsROI Initial Study ResultsStudy Results for Year 3Study Results for Year 3 All Payer Cost AvoidanceAll Payer Cost Avoidance Medicare Cost SavingsMedicare Cost Savings
$$ Additional Additional DaysDays
$$ Additional Additional DaysDays
Medication Events $155,435 373 $53,667 75
Total Falls $196,006 470 $108,518 213
Total Skin Events $268,652 367 $131,350 42
Nosocomial Infections $591,968 905 $252,404 339
TOTAL inpatient cost TOTAL inpatient cost avoidance from 4 avoidance from 4 areasareas
$1,212,061$1,212,061 2,1152,115 $545,940$545,940 669669
Additional Cost of Care
$0
$200,000
$400,000
$600,000
$800,000
$1,000,000
0 5 10 15 20 25 30Over 30 Months
Additional Days of Stay
0200400600800
10001200
0 5 10 15 20 25 30
Over 30 Months
Additional Cost of Care Declined 2.2% per Month Additional Cost of Care
Declined 2.2% per Month
Total Claims by year
Trend in Medical Malpractice Claims
Trend in Medical Malpractice Claims
0.00
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1.00
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2.00
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3.00
3.50
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24 Month Date Range
Fall
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100
0 Pt
Day
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Patient Falls Rate per 1,000 Adjusted Patient Days
Patient Falls Rate per 1,000 Adjusted Patient Days
-1.00
0.00
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Medication Events Rate per 1,000 Adjusted Patient Days
Medication Events Rate per 1,000 Adjusted Patient Days
Follow Up StudyFollow Up Study
• Focus review of reimbursement for inpatient cases having a Medication Event in 2006 for Respiratory Diagnoses only
• 42 of 1710 inpatient respiratory diagnoses patients (2.4%) had reported Med Events during that period
• 26 of 42 (61%) were possibly preventable
• ROI Findings:– All Med Events that were reported as moderate to severe
showed more total cost than estimated reimbursement
• Focus review of reimbursement for inpatient cases having a Medication Event in 2006 for Respiratory Diagnoses only
• 42 of 1710 inpatient respiratory diagnoses patients (2.4%) had reported Med Events during that period
• 26 of 42 (61%) were possibly preventable
• ROI Findings:– All Med Events that were reported as moderate to severe
showed more total cost than estimated reimbursement
• “The number one cause of medical mistakes is not incompetence but confusion”
• Michael Milleson-author- Demanding Medical Excellence: Doctors and Accountability in the Information Age
• “The number one cause of medical mistakes is not incompetence but confusion”
• Michael Milleson-author- Demanding Medical Excellence: Doctors and Accountability in the Information Age