ABSTRACT The financial impact of diagnostic and medical errors and misdiagnoses in medical systems was examined to determine how healthcare organizations (HCO) could become more efficient and cost effective. Various medical conditions that are commonly misdiagnosed were cross-analyzed, and the principles of the diagnosis related group (DRG) system were applied to evaluate the associated expenses of their errors. Ultimately, the concrete costs of misdiagnoses have not been thoroughly assessed. However, further investigation reveals there are approximately one million medical errors per year out of three million medical injuries, resulting in over a billion dollars worth in lost costs. Misdiagnoses of patients, lead not only to increased costs, but also increased …show more content…
physician-patient chair time, testing fees, schedules, and improper medicinal treatment. The above gives rise to the questions - how do these errors financially affect the HCO, and how does one mitigate these costs? Using differential diagnosis, utilizing modern technology, and requesting second opinion from another specialist have shown to decrease medical error costs. INTRODUCTION Regardless of how they are labeled, medical errors, diagnostic errors, and misdiagnoses all contribute to the growing financial costs that HCOs are becoming responsible for. Not only do they increase the amount of physician-patient chair time, they increase the number of medications dispensed, but they also result in unplanned death. Medical errors amount to a significant amount of losses, totaling up to $17 billion in additional medical care costs associated with those errors in 2008. With Medicare making exceptions for medical errors in reimbursement, HCOs are now becoming responsible for financing those preventable losses, which decrease their profitability. HCOs must be wary of these costs and implement measures to prevent medical errors and misdiagnoses. Certain questions must be asked in order to understand how to prevent these expensive occurrences. First, what kinds of injuries or illnesses are most commonly associated errors? It has been evidenced that using differential diagnoses, seeking professional second opinions, and utilizing modern technology can decrease the incidences of medical misdiagnoses. MEDICAL ERRORS What is a medical error? According to Andel, Davidow, Hollander, and Moreno (2012), a medical error is defined as "an act that produces a preventable adverse outcome compared to the natural progression of disease that leads to injury or death” (pg. 2). Unfortunately, Andel et al. (2012, pg.4) suggest that medical errors account for one of the leading causes of death, which could be preventable if actions are taken to ensure patient safety and quality control. In order to better analyze the pertinent statistical data, medical errors are classified into five different areas: “operative; drug-related; diagnostic or therapeutic; procedure-related; and other” (Andel, et al., 2012, pg.5). COST OF MEDICAL ERRORS In research conducted by Andel et al.
(2012), medical errors resulted in $19.5 billion dollars in the United States (US) in 1998 (pg. 4). This figure comprises costs “directly associated with […} ancillary services, prescription drug services, and inpatient and outpatient care” (Andel, et al., 2012, pg.4). Andel, et al. (2014) included mortality rates to that figure that are worth more than 1 million dollars, which result from the dollars lost due to lack of productivity (pg. 4). In general, medical errors are expensive, with post-operative complications “accounting for 35 percent of costs for medical errors and 39 percent of costs for preventable medical errors” (Andel, et al., 2012, pg.). Data gathered by Andel et al. (2012) have yielded that 1.5 million medical injuries out of 6.3 million were preventable if “better polices and practices were followed” (pg. 4). Imagine how much money an HCO could save if healthcare providers were simply “more careful” when collecting history, diagnosing, administering medication, and treating patients. Andel et al. (2012) mentions that the result of such practices would quantify to more than 19 billion of opportunity savings (pg.
4). According to a study by David, Gunnarsson, Waters, Horblyuk, and Kaplan (2013), it was concluded that “medical errors directly impact patient outcomes and hospitals’ profitability, especially since 2008 when Medicare stopped reimbursing hospitals for care related to certain preventable medical errors” (pg. 1). It is essential to note that this initiative by Medicare does deduct money from hospitals; however, it should give incentive to medical providers to ensure proper medical protocol. Because there has been a shift of financial burden to the hospitals, David et al. (2013) states that preventative programs must be implemented to reduce the occurrence of medical errors and to increase patient safety (pg. 1). MEDICAL ERRORS AND INJURIES IN 2008-2009 In the study conducted by David et al (2013), 97 different injury categories were identified with 1 out of the 97 having to occur to be labeled as an injury visit. In order to determine direct medical costs to hospitals, controls were set in place. Any visits with cost range between $300 and $300,000 were included in the visit, because those visits were determined to be suitable indicators real costs to the hospitals. For the injury, the cost associated with the medical error was estimated to be the difference in cost of the control (pg. 2). In 2008, there were a total of 448,060 inpatient visits with 624,830 unique medical injuries, and in 2009 there were 470,561 inpatient visits with 660,688 medical injuries as identified by David et al. (2013, pg. 3) Of the inpatient visits with known injuries in 2008, it was extrapolated that 1,229,349 out of 3,394,164 contained medical errors. Results show that the costs of these errors were $985 million. In 2009, there was an estimated 1,099,382 visits out of 3,392,603 inpatient injury visits that contained medical errors. The costs associated with medical errors increased in 2009 to a total of $1 billion. When these figures were calculated, “the median cost per error to hospitals was $892 for 2008 and rose to $939 in 2009. Nearly one-third of all medical injuries were due to error in both years” (David et al, 2013, pg. 3). It is important to note the age groups, sex, and race are correlated with the incidences of injuries that were associated the medical errors studying by David et al. (2013). Inherently, as age increases, so does the percentage of injuries. Data shows that in the years 2008 and 2009, more than 30% of injuries occurred in patients that were 75 years and older. Also, more injuries occurred in women than in men at a rate of 55% in both years. Evidence also reveals that 62% of the injuries occurred in whites, as opposed to other races (David et al., 2013, pg. 3) The top injury with the highest median costs associated with medical errors in 2008 was infection associated with a central venous catheter. This injury occurred 39,615 times, and 37,635 resulted from medical errors. The median costs per errors amounted to $13,289 with an extrapolated total error cost of $500,130,140. In 2009, ventilator-associated pneumonia topped the list with the most expensive median cost per error at a rate of $14,511, occurring 7,957 times out of 8,376 injuries. The total extrapolated error cost was $115,457,451. However, if total error cost is the focus, then medical errors associated with postoperative infection is evidenced as the most expensive with costs totaling $569,286,560 (David et al., 2013, pg. 5). The aforementioned injuries and errors are evidenced to be the most expensive in 2008 and 2009 per the study conducted by David et al. (2013), but it is worth mentioning, for future preventative measures, the most common medical errors that were identified by the researchers. Pressure ulcers, poste-operative infection, and iatrogenic hypotension were the most common medical errors for both years; and were on the top of the list for most expensive errors, as well. Pressure ulcers and catheter-associated urinary tract infections are considered to be preventable events in a health care setting, therefore never should be part of the ten medical errors listed in this study (David et al., 2013, pg 4). With these events, the costs associated are substantial, and Medicare has taken an initiative to restrict reimbursement for preventable errors, which, essentially, affects the profitability of the HCO (David et al., 2013, pg 6). Ultimately, profit drives businesses; therefore, HCOs must take action to prevent loss associated with medical errors. DIAGNOSTIC ERRORS AND MISDIAGNOSES In a news article reported by Sifferlin (2013), it is defined that diagnostic errors are “diagnoses that [are] incorrect, wrong or delayed, [and are] most likely to result in death” (pg. 2). One can suggest that both medical errors and diagnostic errors are both similar in that both occurrences aggravate overall patient health and may lead to death. They also drive costs of HCOs, for instance, Sifferlin (2013) states since 1986, diagnostic errors have been the most common source of malpractice settlement payments made by practitioners in the US; they are the most expensive, and the most dangerous to the patients’ health (pg. 2). COST OF DIAGNOSTIC ERRORS AND MISDIAGNOSES Diagnostic errors can be quite costly, emotionally, physically, and economically. Though all aspects are all deserving of discussion, just the financial affects will be studied. According to information gathered by Landro (2013), out of 350,000 malpractice claims, about 29% of those claims in 25 years were a result of diagnostic errors. Between the years of 1986 and 2010, those payments amounted to $38.8 billion, which amounted to more than 35% of total payments made towards malpractice claims (pg. 1). Landro (2013) mentions that diagnostic errors are defined as missed, wrong, or delayed diagnosis, without specifying whether or not death is the end result. However, she does add that at least 40% of the claims did result in death (Landro, 2013, pg. 1). In a study conducted by Schwartz, Weiner, Yudkowsky, Sharma, Binns-Calvey, Preyss, and Jordan (2012), preventable costs caused by physicians from making diagnostic errors were estimated (pg. 1). Unnecessary treatment provided was identified and used to estimate those costs using medical records previously reviewed by internists who documented those treatment errors. By collecting data from various HCOs, including, “two academic clinics, two community-based primary care networks, a core safety net provider, and three Veteran Administration (VA) government facilities (Weiner et al., 2012, pg. 1),” it was predicted that those diagnostic errors amounted to $174,000 out of 399 visits. $8,745 of those costs were gathered via medical records without accounting for the correct medical diagnosis. In this particular study, the median costs per visit varied case by case (Weiner et al., 2012, pg. 1). REDUCING MISDIAGNOSES WITH DIFFERENTIAL DIAGNOSES DIAGNOSTIC RELATED GROUPS ADDITIONAL TESTING INCREASES COSTS With misdiagnoses come additional appointments, testing, and treatment. Further testing is costly adding thousands of dollars to medical costs to treat diagnostic errors. For instance,
The Institute of Medicine (IOM) reported in 1999 that between 44,000 and 98,000 people die each year in the United States due to a preventable medical error. A report written by the National Quality Forum (NQF) found that over a decade after the IOM report the prevalence of medical errors remains very high (2010). In fact a study done by the Hearst Corporation found that the number of deaths due to medical error and post surgical infections has increased since the IOM first highlighted the problem and recommended actions to reduce the number of events (Dyess, 2009).
Hospitals are busy places, and with so much going on it is hard to believe that mistakes are not made. However, there are some accidents that should never happen. Such events have been termed ‘never events’ because they are never supposed to happen. This term was first introduced by Ken Kizer, MD, in 2001 (US, 2012). The Joint Commission has classified never events as sentinel events and asks that hospitals report them. A sentinel event is defined as, “an unexpected occurrence involving death or serious physiological or psychological injury, or the risk thereof” (US, 2012). Never events are termed sentinel events because in the past 12 years 71% of the events reported were fatal (US, 2012). Because these events are never supposed to happen, many insurance companies will not reimburse the hospitals when they occur. A study in 2006, showed that the average hospital could experience a case of wrong-site surgery, one example of a never event, only once every 5 to 10 years (US, 2012). This study illustrates how rare a never event is. Hospitals do not want these never events to happen any more than a patient does. To help prevent these errors, hospitals have created policies that, if followed, will minimize the possibility of a mistake. The consequences of never events are devastating and because of this the goal is to make sure that they are eradicated from hospitals and medical facilities.
Surgical errors are seen in every hospital; however, hospitals are not required to report such incidents. Unintended retained foreign objects, often abbreviated as URFOs, are among those events that are often not reported.
Regardless of technological advancement, life-saving skills and abilities and first-world resources, the outlandish cost of healthcare in the United States far surpasses any other country in the world. From price gouging, to double billing, to overbilling, to inefficient and expensive operations, the United States wastes $750 billion every year through our healthcare system. According to the Institute of Medicine (IOM), $200 billion of that astronomical number is due to nothing more than administrative waste. It is estimated that 15 cents of every dollar spent on healthcare is wasted due to inefficient administrative practices.
Hospital medical errors can involve medicines (e.g., wrong drug, wrong dose, bad combination), an inaccurate or incomplete diagnosis, equipment malfunction, surgical mistakes, or laboratory errors. High medical error rates with serious consequences occurs in intensive care units, operating rooms, and emergency departments; but, serious errors that harmed patients may have prevented or minimized. Understand the nature of the error
Woo, A., Ranji, U., & Salganicoff, A. (2008). Reducing medical errors with technology. Retrieved March, 2012, from http://kaiseredu.org
In order to make ones’ health care coverage more affordable, the nation needs to address the continually increasing medical care costs. Approximately more than one-sixth of the United States economy is devoted to health care spending, such as: soaring prices for medical services, costly prescription drugs, newly advanced medical technology, and even unhealthy lifestyles. Our system is spending approximately $2.7 trillion annually on health care. According to experts, it is estimated that approximately 20%-30% of that spending (approx. $800 billion a year) appears to go towards wasteful, redundant, or even inefficient care.
In the United States, hospitals and organizations find ways to help prevent events that should rarely or never occur, often called Never Events. The list of Never Events is made in order to provide hospitals with incentives to make sure the occurrences of them are reduced. As Mrs. Friend states, “If revenue decreases in our health care facilities because of “Never events” this could impact nursing in many ways. The rate of pay, staff to patient ration, availability of modern medical equipment, and our health insurance premiums will all be affected” (Friend, 2009, p. 5). One major type of Never Event that happens more often than it should is a surgical never event. Although, the occurrences of surgical Never Events may not be out of control, we must take into account that they are only reported if they are discovered. In today’s society the occurrence of Never Events should be virtually zero because of the technology available to prevent them.
In today’s College in America there is a debate rather institutions should use the grade scale or pass-fail scale to determine the success of a student. I believe that Institutions in America should use the grade scale rather than the pass-fail scale. A grade scale gives the student an accurate percentage no matter if they passed or fail but with the pass-fail scale it just gives you the letter grade rather than the actual percentage grade.
Schneider, Mary Ellen. "Cost of Medication Errors Tops $3.5 Billion per Year." Internal Medicine News 39.16 (2006): 7. Web.
Rising medical costs are a worldwide problem, but nowhere are they higher than in the U.S. Although Americans with good health insurance coverage may get the best medical treatment in the world, the health of the average American, as measured by life expectancy and infant mortality, is below the average of other major industrial countries. Inefficiency, fraud and the expense of malpractice suits are often blamed for high U.S. costs, but the major reason is overinvestment in technology and personnel.
It is shocking to know that every year 98000 patients die from medical errors that can be prevented(Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.), 2000). Medical errors are not a new issue in our healthcare system; these have been around for a long time. Hospitals have been trying to improve quality care and patients safety by implementing different strategies to prevent and reduce medical errors for past thirty years. Medical errors are the third leading cause of death after heart disease and cancer in America (Allen, 2013). In addition medical errors are costing our healthcare system an estimated $735 billion to $980 billion (Andel, Davidow, Hollander, & Moreno, 2012).
Keeping patients safe is essential in today’s health care system, but patient safety events that violate that safety are increasing each year. It was only recently, that the focus on patient safety was reinforced by a report prepared by Institute of medicine (IOM) entitled ” To err is human, building a safer health system”(Wakefield & Iliffe,2002).This report found that approx-imately 44,000 to 98,000 deaths occur each year due to medical errors and that the majority was preventable. Deaths due to medical errors exceed deaths due to many other causes such as like HIV infections, breast cancer and even traffic accidents (Wakefield & Iliffe, 2002). After this IOM reports, President Clinton established quality interagency coordination task force with the help of government agencies. These government agencies are responsible for making health pol-icies regarding patient safety to which every HCO must follow (Schulman & Kim, 2000).
The health care is extremely important to society because without health care it would not be possible for individuals to remain healthy. The health care administers care, treats, and diagnoses millions of individual’s everyday from newborn to fatal illness patients. The health care consists of hospitals, outpatient care, doctors, employees, and nurses. Within the health care there are always changes occurring because of advance technology and without advance technology the health care would not be as successful as it is today. Technology has played a big role in the health care and will continue in the coming years with new methods and procedures of diagnosis and treatment to help safe lives of the American people. However, with plenty of advance technology the health care still manages to make an excessive amount of medical errors. Health care organizations face many issues and these issues have a negative impact on the health care system. There are different ways medical errors can occur within the health care. Medical errors are mistakes that are made by health care providers with no intention of harming patients. These errors rang from communication error, surgical error, manufacture error, diagnostic error, and wrong medication error. There are hundreds of thousands of patients that die every year due to medical error. With medical errors on the rise it has caused the United States to be the third leading cause of death. (Allen.M, 2013) Throughout the United States there are many issues the he...
Dr. Makary and his colleague Michael Daniel started by studying death rate data (2000-2008) and then hospitalization rates (2013). Using other published studies, they concluded that medical errors cause 251,000 deaths in the USA on average. If you divide this number by 365 days, you’ll see that nearly 690 people die every day due to a medical error. For comparison, 155,000 people die a year from chronic lower respiratory diseases and 146,000 of accidental injuries.