As mentioned previously in Washington Report, the push is on to reduce medical errors in the US. The focus has now shifted to Congress. A bipartisan coalition of senators recently urged lawmakers to approve a bill to require healthcare facilities to establish safety procedures and report instances of serious error. The bill’s sponsors, Senators Charles Grassley, R-IA; Joseph Lieberman, D-CT; Bob Kerrey, D-NE; and Richard Bryan, D-NV, want to reduce the medical error rate by 50% over the next 5 years.
The measure known as SAFE (Stop All Frequent Errors in Medicare and Medicaid Act of 2000) is based on recommendations from the Institute of Medicine report published last November. Among other things, the institute found that as many as 98,000 patients die every year because of medical mistakes.

SAFE also would establish a Center for Patient Safety within the Agency for Health Research and Quality. Designed to improve safety and reduce the incidence of medical errors, the Center would conduct research and dispense grants related to medical error reduction. It also would establish national goals for patient safety and mechanisms to track such goals.

The measure would target healthcare purchased through Medicare and Medicaid. Facilities that want to participate in these 2 federal programs, including hospitals, critical access hospitals, skilled nursing facilities, and home health agencies, would have to meet the requirements of the act.
“Through Medicare and Medicaid, we can work to reduce medical errors in almost every health facility in the country,” said Sen. Lieberman.

SAFE would require health institutions to establish a medical safety program that produces measurable reductions in error. The program would require the reporting of deaths and serious injuries and the identification of their causes. Under the proposal, health institutions would have to take steps to prevent further accidents.

When asked about the role of laboratories in all this, American Clinical Laboratory Association president David Sundwall, MD, said, “ACLA is very interested in it. We think it presents an opportunity for labs to get some good press because we have a very good record and a good story to tell.” He added that research indicates that medical errors occur because of system failure. “Laboratories believe they can help with those system problems.”

Under the bill, medical institutions would have to report incidence of errors to state public health departments, Medicare peer review organizations, and relevant accrediting organizations. Facilities would then select one of those three entities to oversee whether they are complying with the law’s requirements. The information concerning errors would be stripped of identifiers, then provided in aggregate form to federal officials for research and other purposes.

The Department of Health and Human Services would not publicize the name of an institution unless the facility demonstrates a pattern of poor performance for more than 2 years, and fails to comply with the reporting requirements and to take steps to address safety problems.

While there is growing public support for efforts to reduce medical mistakes, groups representing physicians and hospitals are concerned that the mandatory reporting of errors would result in additional lawsuits. To win passage, Capitol Hill experts say, lawmakers will have to come up with a way that provides physicians and hospitals with protections from legal action.

Regional carriers still on drawing board

HCFA is indicating that it plans to phase in a regional carrier system to process Medicare Part B laboratory claims as required by the 1997 Balanced Budget Act. But the phase-in is not expected to start until sometime next year. The use of regional carriers as well as uniform lab payment policies are intended to make the handling of lab claims more consistent across carrier areas.

Under the budget act, up to 5 regional carriers were scheduled to be in place by July 1, 1999. But HCFA has taken no action to get the effort going. “We think this is long overdue and we are not happy with the delay,” says ACLA’s Sundwall.

HCFA maintains that the delay was due in part to year 2000 compliance work. But Sundwall says that some HCFA staffers have reservations about the regional carrier requirement. Even so, the HHS Office of Inspector General has said it favors the use of regional carriers to handle lab claims. The OIG believes that the regional carrier approach has worked well for durable medical equipment claims.