Concern, Misperceptions Describe Physician Views On CMS "Never Event" Policy, QuantiaMD Finds

Main Category: Litigation / Medical Malpractice
Also Included In: Medicare / Medicaid / SCHIP
Article Date: 06 Nov 2008 - 1:00 PDT

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Virtually none of 11 serious medical errors is 100% preventable, regardless of hospital readiness, according to a national survey of physicians on QuantiaMD, an online clinician community.

On October 1, the Centers for Medicare and Medicaid Services (CMS) began withholding additional payments to hospitals for the care delivered to patients who suffer one of 11 identified serious and preventable adverse events, catheter-associated UTIs being one of them. The national QuantiaMD survey was designed to assess physician awareness of the new CMS reimbursement policy, understand physician perspectives on preventability, and learn how ready physicians feel their institutions are for a "zero tolerance" payment environment.

"Very few physicians felt that (these events) are completely or even largely preventable," says Robert M. Wachter, MD, professor of medicine at University of California at San Francisco, Investigator of the QuantiaMD Survey, and Moderator for the Safety and Reimbursement education series. "This I think led to the skepticism physicians have about the CMS policy, feeling a demand for complete preventability is unfair."

Results point to a great need for sharing evidence

If nothing else, the QuantiaMD survey revealed that the CMS policy represents a major sea change in the way healthcare is paid for in the US, and how seriously it is being taken by institutions. Nearly 70% of physicians said the policy is regularly discussed at medical staff and departmental meetings - and 6% of respondents said "it's all we hear about."

Perhaps the most important findings of the survey are those related to physician views on preventability of these medical errors. For example, says Wachter, "more than 70% (of respondents) believe that leaving foreign objects in patients following survey is completely preventable. But at this point that is actually debatable. Despite almost self-evident in its preventability, it's actually hard to completely prevent these errors. We need new technologies like bar coding and scanners."

While Wachter agrees with much of the sentiment about preventability, he points to new evidence of preventability. For example, the survey found that only about 5% of physicians believe that vascular-catheter-associated infections are 100% preventable. Yet, data from the Keystone Project at Johns Hopkins has shown that such infections are indeed almost 100% preventable.

"This series is a great opportunity to share evidence-based best practice in a way that will help patients and providers," says Wachter.

Misperceptions abound

"Whatever feelings came across in this survey and from the many comments by physicians, it is clear there is a great deal of interest in this topic among doctors," says Wachter. "More than 70% of participating physicians knew of this initiative by Medicare, which, in the physician community, is a remarkably high level of awareness."

Wachter points out that other data from QuantiaMD's national survey suggests that physicians displeasure with this policy shift may have more to do with misperceptions than an informed opinion. For example, 44% of participating physicians didn't understand the narrow scope of the policy, and 58% believe that the economic impact of the policy will exceed $1 billion in its first year. Medicare itself estimates that the first year impact will be just $22 million across several thousand hospitals.

"Clearly there is a great opportunity to educate physicians with this series from QuantiaMD," concludes Wachter.

A total of 1,727 physicians participated in this survey.

Dr. Wachter reveals and discusses the results of QuantiaMD's national physician survey on Never Event preventability and readiness

Dr. Wachter describes the CMS "never events" program on QuantiaMD.

QuantiaMD is an online clinician community improving the quality and safety of healthcare by clinicians participating in world-class education, interactive cases, field research and patient discussions using breakthrough mobile and web technology.

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