Disclosure of medical mistakes is sought

A leading Massachusetts lawmaker wants hospitals to disclose publicly when they commit serious mistakes and to forfeit payments for the care of victims of these errors, part of a broad push in the Legislature and from the governor's office for less secrecy in healthcare.

On Thursday night, the Massachusetts House of Representatives passed a sweeping healthcare bill that includes a requirement for hospitals and doctors to provide more public information on the quality and cost of care. The bill would establish a ''health care quality and cost council," which would post on a website individual hospitals' and doctors' average fees for dozens of procedures. The council also would publish unspecified quality comparisons.

Urged on by the state's insurers, Senator Richard T. Moore, cochairman of the Legislature's Joint Committee on Health Care Financing, is drafting a bill that would take a different approach. He wants hospitals to tell the public about the occurrence of 27 specific mistakes called ''never events," which are rare but so serious and preventable that public health leaders say they should never happen to patients.

His bill would require hospitals to donate to a state patient safety center payments from insurers, government programs, and patients for the hospital stay and associated costs when staff commit one of the specific errors. They include mistakes such as leaving a clamp inside a patient during surgery, operating on the wrong patient or body part, a patient falling in the hospital and dying from his or her injuries, and seriously injuring a patient by giving him or her the wrong drug.

''These are really grievous errors; they should never happen and we shouldn't be paying for them," said Moore, a Democrat from Uxbridge. ''And making it public puts pressure on the institution to correct the problem. The hospital risks losing not just thousands of dollars for that case, but millions in lost business."

Pressure is growing on hospitals to disclose information on the cost and quality of medical care that previously has been kept from the public or not collected, as a way to hold hospitals accountable for the billions of healthcare dollars they receive annually and encourage improvements in care. Advocates of greater transparency believe it will help patients compare hospitals when deciding where to seek treatment, creating market pressure on hospitals to improve care and lower costs. Many hospital executives and doctors say they favor more openness, but worry that some of the data used to compare their institutions does not present the whole picture and could mislead patients.

Senate President Robert E. Travaglini wants to establish a ''Consumer Health Care Quality & Cost Information Board" as part of his healthcare reform legislation, similar to the council in the bill approved by the House. Governor Mitt Romney last month launched his administration's own healthcare consumer website that uses dollar signs and stars to rate hospitals. And Consumers Union, the nonprofit organization that publishes Consumer Reports, is pushing legislation in Massachusetts and other states that would require hospitals to disclose publicly the number of patients who contract dangerous infections while in the hospital.

The mandatory reporting provisions of Moore's bill are based on a Minnesota law passed in 2003 and implemented this year. This law doesn't require hospitals to forfeit payments when there is an error, but Massachusetts health insurers adopted that strategy from Minnesota's third-largest insurer, HealthPartners, which stopped paying for ''never events" on Jan. 1.

Moore wants hospitals to donate payments to the Betsy Lehman Center for Patient Safety and Medical Error Prevention, a program the state created last year to work with hospitals and patients to implement safety initiatives. It is unclear how it would be enforced.

The center was named after the Boston Globe health columnist who died after a physician accidentally prescribed four times the intended dose of breast cancer medication.

Dr. Marylou Buyse, president of the Massachusetts Association of Health Plans, said that too often, the healthcare system financially rewards errors. ''There really are some perverse incentives," she said. ''When patients have complications, the doctors and hospitals will get paid more."

Karen Nelson, senior vice president of clinical affairs for the Massachusetts Hospital Association, called the legislation ''very punitive" and unnecessary because hospitals already report ''never events" to the state Department of Public Health, which investigates errors and can demand improvements. The public can obtain some information on these errors by filing a written request with the health department, but the process is complicated and consumers would not have an easy way to compare hospitals.

Nelson said hospital executives and doctors now also routinely disclose serious errors to patients and often waive medical bills.

''Never events" -- a list of serious errors compiled by the National Quality Forum, a nonprofit group that develops strategies to measure and improve quality -- are rare, but they do occur. Minnesota hospitals reported 99 such mistakes from July 2003 through Oct. 2004.

In Massachusetts, the Board of Registration in Medicine, which licenses doctors and collects information on errors, reported 24 ''wrong site surgeries" last year but did not identify the hospitals in its report.

Healthcare leaders say the push for disclosure is partly the result of soaring costs. ''The continued run-up in healthcare costs is going to lead to a far more invested consumer than we've seen historically," said Charles D. Baker, chief executive of Harvard Pilgrim Health Care, the state's second-largest insurer, which titled its 2004 annual report ''The Cost of Not Knowing."

Hospital executives say they philosophically favor more public disclosure, and many participate in the federal Medicare program's public report card, which compares hospitals on whether they provide 20 different types of care considered important for treating heart attacks, heart failure, pneumonia, and preventing infections after surgery. The agency's website focuses on processes, such as providing aspirin to heart attack patients, which hospitals favor over reporting results, such as the percent of heart attack patients who die. Some hospital executives argue that report cards that focus on outcomes cannot fully adjust for whether hospitals treat sicker patients who are more likely to die, rather than provide inferior care.

Dr. Thomas Lee, president of the physician network for Partners HealthCare System, the parent organization of Massachusetts General and Brigham and Women's hospitals, said evidence so far shows that few consumers use public rating systems to choose a hospital or doctor, suggesting they have little impact on a provider's business. In an article in September in the New England Journal of Medicine, Lee cited surveys showing that between 11 percent and 22 percent of the public looked at quality ratings for hospitals and doctors, but just 1 percent to 2 percent made a change in providers based on the information.

Still, he said he believes public report cards do lead hospitals to improve treatment, because executives and doctors want to be seen even by each other as performing well.

Liz Kowalczyk can be reached at kowalczyk@globe.com.