News that the federal government had threatened to strip a key financial lifeline at the University of Chicago Medical Center after the death of Chicago business executive James Tyree reflects how seriously the government and health industry are dealing with medical errors.
Following an investigation into Tyree’s death, the U.S. Centers for Medicare and Medicaid Services announced in a public notice Wednesday that it was terminating U. of C.’s Medicare payments on April 28. It determined “deficiencies … so serious they constitute an immediate threat to patient health and safety.”
Although Tyree, a financial executive who also was chairman of the parent company of the Chicago Sun-Times, was not mentioned in the legal notice, the Tribune confirmed that the error described was in reference to a March 14 incident at the hospital involving Tyree. He died two days later from an air embolism following the removal of a dialysis catheter while he was being treated for pneumonia. The catheter was removed incorrectly by a physician’s assistant, federal officials said Thursday.
After being notified of the investigation in late March, the U. of C. said it submitted a “thorough plan of correction to demonstrate continued and sustained compliance with the Medicare conditions of participation.” The hospital said Thursday that it was told its Medicare program will remain intact.
The error at the U. of C. that contributed to Tyree’s death falls into a category some health industry groups refer to as a “never event,” which means it was a preventable situation.
The federal government typically launches an inquiry following an adverse event brought to its attention, and that can lead to the threat of a medical facility losing Medicare funding. But government officials will also threaten to cut off payments over other issues, such as building-code violations. In most cases, medical facilities quickly address the problems.
The investigation and the subsequent events highlight how the government and those who pay for medical services are focusing on quality care.
More than 100,000 Americans die annually from preventable medical and medication errors, according to the Institute of Medicine. And poor-quality medical care costs employers nearly $400 billion annually, according to a 2003 study by the Chicago-based Midwest Business Group on Health.
“To terminate a hospital — it’s rare but it does happen,” said Elizabeth Surgener, a spokeswoman for the Centers for Medicare and Medicaid Services. “It’s not uncommon for a facility to be cited throughout a survey process. Typically, a facility is able to make appropriate changes to their systems and processes that bring them back into compliance, which is ultimately our goal.”
Medicare and most private health insurance companies have escalated their focus on medical errors, refusing to pay for poor-quality care, particularly when preventable errors are involved, such as a doctor leaving a sponge in a patient following heart surgery or when the wrong limb is amputated.
This week, the Obama administration announced an initiative with insurers, hospitals and business leaders that has the goal of reducing certain medical errors by 40 percent over the next three years. The administration also wants to cut readmissions to hospitals by 20 percent.
Under health care reform, as well as contracts that private employers and insurers are negotiating with doctors and hospitals, the quality of medical care provided is being measured and tied to performance. Providers can get enhanced payments for improvements or be kicked out of insurance company networks for poor care.
The 53-year-old Tyree was diagnosed last year with stomach cancer and had been admitted to the U. of C. hospital with pneumonia. The Cook County Medical Examiner last month said his death was due to the improper removal of his catheter, but also listed pneumonia and metastatic cancer as secondary causes.
In a statement Thursday to the Tribune, the Medicare program’s administrator said an investigation of U. of C. found “immediate jeopardy due to the hospital’s failure to ensure that facility staff were adequately trained and showed competency in conducting such procedures.” The probe was conducted by the state Department of Public Health and the Joint Commission, a hospital accrediting agency.
The U. of C. told investigators it had policies in place that ensured physician’s assistants and certain other medical personnel were trained and responsible to perform the catheter procedure known as “central line placement,” but when investigators looked for the policies they could not find them, a Medicare spokeswoman said.
On March 25, the Chicago office of the Centers for Medicare and Medicaid Services issued a notice of termination from the Medicare program for the hospital. The health insurance program for the elderly is a primary revenue source for all hospitals.
Termination from the Medicare program is the only action the agency can take against a hospital, a Medicare spokeswoman said. Civil fines, however, can be levied against nursing homes and other long-term care facilities, she said.
“Documentation, which was at the center of the investigation, has been improved and centralized,” the medical center said in Thursday’s statement. “The investigations confirmed that all related personnel have appropriate training, experience, competency and credentialing.”
