Becker's Hospital Review

63 CARE DELIVERY Medical Errors — No. 3 Cause of Death in the US, Study Unveils By Heather Punke T he CDC lists chronic respiratory diseases as the No. 3 cause of death in the U.S., behind heart disease and cancer, but researchers from Baltimore-based Johns Hopkins beg to differ. ey analyzed data from an eight-year period and found medical errors are the true third leading cause of death in the U.S. Research published in e BMJ May 3 shows medical errors kill more than 250,000 Americans each year, while the CDC says respiratory disease kills close to 150,000 every year. To find those numbers, researchers examined four separate studies analyzing medical death rate data from 2000 to 2008. ey then used hospital admission rates from 2013 and extrapolated how many deaths stemmed from medical errors. Martin Makary, MD, lead author of the study, says the discrepancy comes from the way the U.S. compiles national health statistics. "Our national health statistics…do not take medical care gone wrong as a cause of death," he says. ings like diagnostic errors, medication errors, communication breakdowns or system errors that can lead directly to a patients' death are not counted, because national health statistics are based on ICD billing codes. While the number of medical errors is clearly troubling, the larger problem lies in how the statistics are calculated. "e list we generate each year as a country of our national health statistics is a big deal," Dr. Makary says. "It informs our NIH [National Institutes of Health] funding, public health campaigns and awareness efforts in the medical community and the public." Because national health statistics don't recognize the role of medical errors, research on the problem is "vastly underfunded, and it's very difficult for patient safety and quality researchers to get the support and funding it deserves relative to other causes of death listed in the national health statistics," says Dr. Makary. To fix the problem, Dr. Makary says the nation needs to allow physicians to branch beyond ICD codes to list the true cause of death. Additionally, physicians need to be able to discuss medical errors "without creating a litigation frenzy," he says. Dr. Makary and three colleagues from Johns Hopkins also penned an open letter to omas Frieden, MD, director of the CDC, urging him to add medical errors to the CDC's list of the most common causes of death in the county and to move away from using ICD codes to allow physicians to list medical error as a cause of death. Bob Anderson, chief of the CDC's mortality statistics branch, told NPR that medical care complications are in fact listed on death certificates and captured in ICD codes, but the underlying condition is what is used in national health statistics. Additionally, he said because the current way of counting causes of death aligns with international guidelines, it would be hard to change "unless we had a really compelling reason to do so." n ACOs Flourish or Fail in These 27 States By Ayla Ellison A s of the end of January, the number of active accountable care organizations across the nation increased by 94 over the past year to 838, according to a recent report by Leavitt Partners and the Accountable Care Learning Collaborative published in Health Affairs. ACO growth has varied across the country, with accountable care failing to take hold in some regions. With between 28 and 69 ACOs each, California, Florida, Illinois, Massachusetts, New York, Pennsylvania and Texas are the states with the most ACOs, according to the report. The states with the fewest ACOs — Alaska, Idaho, Montana, North Dakota, South Dakota, Vermont and Wyoming — each have between two and three ACOs. Nationally, 8.9 percent of the population is covered by ACOs. The states with the highest ACO penetration — the percentage of lives in a market that are covered by an ACO contract — varies from those with the most ACOs. With greater than 20 percent of residents covered by an ACO contract, Illinois, Iowa, Maine, Massachusetts, Michigan, Minnesota, New Hampshire, New Jersey, Ohio, Oregon, Utah, Vermont and Wisconsin, are the states with the highest ACO penetration. "High penetration may be driven by competition among multiple providers within a market who are all adopting accountable care contracts, or it can be driven by a single ACO run by a dominant provider that is able to take risk for a large portion of the population," according to the report. In states with the lowest ACO penetration — Alabama, Mississippi and West Virginia — between zero and 3 percent of residents are covered by an ACO contract. n SSM Health to Operate 27 Retail Clinics in St. Louis Walgreens By Shannon Barnet S t. Louis-based SSM Health has signed an agreement with Walgreens to extend the organizations' partnership. Under the agreement, SSM Health will also own and operate 27 retail clinics within Walgreens stores across the St. Louis area. Once the clinics transition to SSM Health this fall, they will each be renamed SSM Health Express Clinic at Walgreens. "By combining the convenience of Walgreens locations with the personalized care and expertise of the SSM Health Medical Group, we will provide a seamless healthcare experience for our patients," said James Bleicher, MD, regional president of the SSM Health Medical Group and ambulatory services in St. Louis. "This means care that is truly integrated whether you visit an SSM Health physician, hospital, urgent care or Express Clinic at Walgreens." n

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