Care Coordination: A “Life or Death” Issue Today?

a-doctor-holding-a-medical-error-sign

 

Researchers at Johns Hopkins University recently published a study indicating “Medical Errors” are a leading cause of death in America. According to their research, the top three causes of death in America during 2013 were:

  1. Heart Disease (611,105)
  2. Cancer (584,881)
  3. Medical Errors (251,454)

“Wait a minute…the Johns Hopkins report can’t possibly be true, can it?  If Medical Errors really are that big of a contributor to the annual death count in America, why isn’t that category listed in the National Vital Statistics Report?”

Great question with a simple answer!  It is not listed because "Medical Errors" is not an official category that is tracked.

 

The National Vital Statistics Report for 2013 doesn’t list “Medical Errors” in their top 10 causes of death for 2013 or for 2012. Their list positions “Respiratory Disease” as ranking #3.  Here is the NVSR Top 10 listing for 2012/2013:

NVSR 2013

So how did Martin Makary and Michael Daniel, the Johns Hopkins researchers,  conclude “Medical Errors” are the third leading cause of death in America?

Makary and Daniel examined four separate studies that analyzed medical death rate data from 2000 to 2008, and extrapolated that rate to total hospital admissions for 2013.  The resulting number  of deaths (251,454), if accurate, would position Medical Errors solidly in the #3 spot, significantly above Respiratory Disease which accounted for 149,205 deaths in 2013.  Another talking point the Hopkins researchers put forth is their suggestion that it is systemic problems such as the lack of care coordination that significantly contributes to the annual mortality rate, more so than individual provider errors. 

Not surprisingly, shortly after the Hopkins researchers published their study, industry professionals came alive with comments challenging their conclusions.  Within three weeks of the study being published, Medscape published an article entitled “Who Believes That Medical Error Is the Third Leading Cause of Hospital Deaths?” (http://www.medscape.com/viewarticle/863788), and their article was peppered with comments critical of the Hopkins paper with an occasional supportive comment thrown in to the mix.

So what should we believe in regards to the Hopkins study? Are Medical Errors really the third leading cause of death in America?  Is the systemic lack of care coordination really a significant contributing cause of patient mortality?

I cannot say “YES” with certainty, but I do believe that Medical Errors contribute significantly to patient adverse events, up to and including patient death.

Many of you know that the FDA maintains a database that tracks adverse events (“FAERS”) including patient deaths, and their data lends support to the Hopkins conclusions.  Take a look at this PowerPoint slide from a presentation I made to numerous healthcare providers during 2015.

The information extracted from the FAERS database indicates that adverse drug reactions alone resulted in over 700,000 serious events during 2013; patient death was that serious event 117,752 times. Let that sink in for a moment. The FAERS database documents that 117,752 patients died in 2013 due to adverse reaction to prescribed medications.  That one “Medical Errors” category alone would qualify as the 6th leading cause of death in America during 2013 if the data is accurate; add in the deaths due to other types of Medical Errors and it is very feasible that the conclusions Makary and Daniel put forth are correct.

Is the lack of care coordination a life or death issue?  In some cases, the answer is obviously “YES!”

FAERS slide

While writing this blog  I was interrupted by a call from a colleague who needed some advice and who also needed to vent her frustration related to recurring systemic failures in modern healthcare.  Her husband had just had a major surgical intervention related to his heart and she had several prescriptions from his various healthcare providers that she was attempting to have filled at a local pharmacy.  As the pharmacist was reviewing the various scripts from multiple providers, he alerted my friend that he could not fill all of the prescriptions as written because it would put her husband at significant risk of a drug on drug adverse reaction.  In this case an alert pharmacist prevented what could have been a very serious problem from occurring, so in that sense the “system” worked, but what would have happened if my friend had chosen to fill the various prescriptions at two or more pharmacies?  Would the lack of care coordination between the various providers have resulted in a catastrophic adverse event for my friend’s husband?  We will never know.

Interestingly, recently proposed MACRA rules list a significant number of care coordination activities as being high priority items that are heavily weighted by CMS in their new MIPS scoring system.  Also, recognizing that CMS recently began reimbursing providers for non face-to-face care coordination of patients with two or more chronic conditions via a dedicated CPT code (99490),  it is easy to conclude that systemic care coordination is a high priority goal with CMS.

Will improved care coordination between all of a patient’s healthcare providers reduce the number of deaths attributed to Medical Errors?

Intuitively we all know the answer is “YES.”

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