It’s too pat to say that all medical care is personal, but everyone reading this has had some contact with the system as either a patient or an advocate, and those encounters can sometimes be a motivator. Take, for instance, the study “A New, Evidence-Based Estimate of Patient Harms Associated With Hospital Care” in the Journal of Patient Safety (JPS).

In 1999, the Institute of Medicine’s To Err Is Human study estimated that 98,000 deaths occur each year because of medical errors. Data gathering and processing advanced, and in 2010, the government estimated that bad hospital care resulted in about 180,000 deaths annually.

Still too low, argues John T. James, PhD, author of the JPS study. Between 210,000 and 440,000 patients die in hospitals each year because of human error, he says. He cites examples, such as the 19-year-old runner whose cardiologists neglected to warn him not to run.

“Having not been warned against running, he resumed running and died three weeks later while running,” the study states. That runner was James’s son.

His findings are based on four recent studies that target preventable adverse events (PAEs) that happened to 4,200 patients between 2002 and 2008. The categories are:

  • Errors of commission
  • Errors of omission
  • Errors of communication
  • Errors of context
  • Errors in diagnoses

James’s baseline estimate is 210,000 preventable deaths at hospitals each year. But because not all the data, such as diagnostic errors, are captured, the number could be more than twice as high.

Lucian Leape, MD, sat on the committee that wrote To Err Is Human. He tells ProPublica that James’s estimate is on target. Leape and other experts think it’s time to put the IOM’s 98,000 figure to rest.

The American Hospital Association disagrees, telling ProPublica that the screening method James used (the Global Trigger Tool) cannot really make a nationwide estimate.

James writes: “In a sense, it does not matter whether the deaths of 100,000, 200,000, or 400,000 Americans each year are associated with PAEs at hospitals. Any of the estimates demands assertive action on the part of providers, legislators, and people who will one day become patients.”

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There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.