As part of the Affordable Care Act, hospitals with high rates of adverse events among patients—such as hospital-acquired infections, medication errors, or surgical mishaps—are now subject to penalty from the Centers for Medicare & Medicaid Services (CMS). Under the new rules, large, urban public teaching hospitals are being penalized the most. But health policy expert Ashish Jha of Harvard School of Public Health (HSPH) doesn’t think major teaching hospitals are necessarily bad places to get care; rather, he thinks that the way hospital safety is measured needs improvement.
In a June 23, 2014 post on his blog “An Ounce of Evidence,” Jha, professor of health policy and management at HSPH, explained that CMS evaluates hospitals’ safety records, in part, using complication codes found in billing data. But these metrics may be problematic because hospitals vary in how hard they look for complications and in how diligently they code complications, Jha wrote. Moreover, large teaching hospitals’ higher rates of adverse events may have a lot to do with their generally sicker, more complication-prone patient population—which CMS’ evaluation doesn’t fully take into account.
Jha thinks that measuring adverse events a different way—using electronic health records that capture clinically-based data, instead of using billing codes—could give a more accurate picture of hospital safety. “The technology is there,” Jha wrote. “It just requires someone to decide that improving patient safety is important—and that clinically based metrics are useful.”
Read Ashish Jha’s blog post: Penalizing Hospitals for Being Unsafe