‘Patient Safety’ Initiative Could Lead to Rationing

Published February 1, 2002

The federal government’s release of $50 million in patient safety grants may be used to create a national patient information system, warns the Citizens’ Council on Health Care (CCHC), a Minnesota-based independent health care policy organization.

The U.S. Department of Health and Human Services (HHS) released the grants late in November, 2001.

According to Twila Brase RN, president of CCHC, “Thirty million dollars will be directed into 46 projects focused on improved data collection, use of computers, and information technology. With so much money to be had, the patient’s right to privacy and protection from government interference is in serious jeopardy.”

Dollars and Strings

Brase points to two specific examples of HHS access to individually identifiable patient data: the OASIS home health data collection system and the recently released federal medical privacy rule.

  • The federal Outcomes and Assessment Information System (OASIS), launched in 1999, collects—without patient consent—approximately 95 items of data on all adults receiving medical care other than maternity care. Home health agencies are required to submit the data to qualify for reimbursement from Medicare and Medicaid.
  • The privacy rule, released in April 2001 and set for implementation in April 2003, requires doctors, hospitals, and health plans to open their medical records on any day at any hour to HHS without patient consent or a search warrant. In addition, the regulation permits disclosure of data to medical and policy researchers, public health officials, law enforcement officers, and other persons and agencies without patient consent or a search warrant.

Brase stated in a CCHC new release, “We are particularly concerned that a national health information system may eventually lead to federal control of the nation’s entire health care system and its health care professionals. Electronic oversight could be a mighty tool in the arsenal of federal officials interested in rationing health care services. Regardless of a patient’s need for care, fearful doctors may be unwilling to move forward without federal approval.”

Medical Errors Overstated

Brase agrees medical errors do occur, but says there is disagreement on the definition of medical error and the extent of errors occurring. She cites recent studies from the Indianapolis-based Regenstrief Institution (1999) and researchers in the Department of Veterans Affairs (2000) that challenged the findings of the highly publicized studies done by the Institute of Medicine. The 1999 IOM studies claimed 44,000 to 98,000 deaths per year.

Research led by Rodney A. Hayword of the Veterans Affairs Center for Practice Management and Outcomes Research, reported in the July 25, 2001 issue of the Journal of the American Medical Association, confirms Brase’s skepticism regarding the significance of the medical error problem. Hayword and his colleagues calculated the number of deaths due to medical error between 5,000 and 15,000 a year. (See “New Study Says Medical Errors Are Overstated,” Health Care News, September 2001.)

Basic Problems

Brase, a registered nurse, also thinks it does not require millions of dollars, scores of researchers, or comprehensive national databases to understand some of the underlying causes of medical error. Brase puts the blame on managed care tactics and the reimbursement schemes of HMOs and government programs.

“Patient quotas,” says Brase, “along with long waits for referrals, change of doctors, drug formularies, loss of the patient-doctor relationship, gag rules, low professional morale, prior authorization delays, increased paperwork, poor reimbursement rates, market consolidation, use of non-medical staff, and inadequate hospital staffing have led to many of these human errors.”

The way to improve patient safety and reduce medical error, according to Brase, is to start eliminating corporate- and government-managed care and put patients and professionals back in charge of health care.

For more information . . .

visit the Web site of the Citizens’ Council on Health Care (CCHC), a nonprofit 501(c)(3) independent national health care policy organization based in St. Paul, Minnesota. http://www.cchconline.org.