As Congress debated what to do about federal spending on healthcare, one critical issue did not get adequate consideration: How to improve the quality of hospital care. Hospital care is a big component of the nation’s overall health care spending. Spending on hospital care totaled $1.5 trillion in 2023, representing nearly one third (31%) of national health expenditures in that year.
There is considerable peer-reviewed research that quantifies the need for improvements in the quality of that care. According to a 2023 report in the prestigious New England Journal of Medicine, nearly 1 in 4 patients who are admitted to hospitals in the U.S. will experience harm and approximately one fourth of the events were preventable.
And that additional harm drives up costs. Take, for example, the issue of readmissions. If a hospital patient has to be readmitted for a complication, that adds costs, which is why regulators monitor such problems.
The quality of care in hospitals is not an issue that is evenly distributed across the nation. Every year, national rankings are released that examine Medicare data to see how well the nation’s hospitals perform. Typically, New York State lags most of the nation.
A key way to improve patient safety is making the quality of health care delivery transparent.
Perhaps the most comprehensive safety guide is the hospital ranking issued by The Leapfrog Group (http://www.leapfroggroup.org/). Leapfrog was created over 20 years ago by large businesses that were frustrated by the lack of quality health data. Those businesses usually negotiated coverage for their employees, yet lacked the data to comparison shop. The Group was established to help them to make health care decisions. The Group issues its ranking twice a year.
In its most recent report, Leapfrog Group found that New York State ranked 31st nationwide in terms of quality, with only one quarter of hospitals receiving an “A” grade. Why do New York hospitals perform comparatively so much worse? In July 2019 the director of Leapfrog Group, explained what she knew about New York’s hospital safety:
“The system as a whole didn’t seem to have emphasized safety. We’ve seen other states work together and look at what’s working well at other states and implement it. It just doesn’t seem to be happening in New York. It has to be front of mind every single day in a hospital.”
Of course, being ranked only 31st in the nation means there are other states that are worse off. Yet, the focus on patient safety gets short shrift.
Costs are not the only reason why the issue should be at the top of lawmakers’ consideration. If hospital patients get harmed by the care that they receive, it’s a big problem for them as well.
One national study found that medical errors are the “third leading cause of death in the US. One study reported that approximately 400,000 hospitalized patients experience some preventable harm each year, while another estimated that >200,000 patient deaths annually” as the result of these preventable harms.
The financial costs are staggering, “costing the healthcare system $20 billion each year and others approximating healthcare costs of $35.7 to $45 billion annually for hospital-acquired infections alone.” These “medical errors also negatively impact the patient, their family, involved clinicians and support staff, the healthcare facility, and the community.”
These analyses raise serious questions for Congress. Why is so little being done to invest federal dollars on patient safety? What is the federal government now doing to respond to the national rankings that have consistently found poor quality in hospitals?
Failing to get answers to those questions not only costs taxpayers money, but puts too many Americans’ health at risk. Americans deserve a more thorough, thoughtful examination of quality and safety issues when it comes to healthcare spending.
Blair Horner is senior policy advisor with the New York Public Interest Research Group.
The views expressed by commentators are solely those of the authors. They do not necessarily reflect the views of this station or its management.
