Just a few years ago, Pennsylvania was moving towards the monitoring of “preventable serious adverse events” or “never events” in acute care facilities in Pennsylvania. Progress on “preventable adverse events” has been inordinately slow but substantial in the Commonwealth. Unfortunately, the progress coincides with financial strains. The Pennsylvania Health Care Cost Containment Council reported this year that Pennsylvania acute care hospitals experienced a reduction in net income of $865 million from FY08 to FY 09. The loss was largely due to losses in investment income and other non-operating income.
The problem for patients will be whether healthcare providers in this environment will be willing to take measures needed to make meaningful improvements in the quality of healthcare at a time when providers face the prospect of not being paid for poor care.
On June 10, 2009, Pennsylvania finally passed the Preventable Serious Adverse Events Act, simply Act 1. P.L. 1, 36 P.S. §§ 449.91 – 449.97. This was a major piece of legislation for the Commonwealth and its impact will be sweeping. Whether this heralds in a new and improved system remains to be seen since it is still in its infancy. Specifically, while the effort is intended to improve the quality of care, in the short-term it is likely to cause a serious disruption in that quality. Much will depend on the extent to which the patients and their loved ones advocate for proper care.
The language in Act 1 is sweeping. The events at issue are described in Section 449.92 as:
An event that occurs in a health care facility that is within the health care providers control to avoid, but occurs because of an error or other system failure and results in a patient’s death, loss of body part, disfigurement, disability or loss of bodily function lasting more than sevn days or still present at the time of discharge from the health care facility. The events shall be included on the list of reportable serious adverse events adopted by the national quality forum ir in a bulletin provided by this act.
Three agencies in Pennsylvania are charged with duties including DPW, the Department of Health and the Department of State.
Under the terms of Act 1, not only will the health care provider be prevented from seeking payment from either the patient or the payor (such as insurance company) but they cannot charge for services to correct or treat the condition. A separate provision has been made for nursing facilities. DPW is charged with the responsibility for these entities and issued a proposed bulletin for public comment on October 16, 2010. The bulletin lists 26 specific events as diverse as Stage 3 and 4 pressure ulcers acquired after admission to the nursing facilities and falls while being cared for in a nursing facility.
The Department of Health is responsible for updating the list of reportable events adopted by the National Quality Forum and investigating complaints against health care facilities. The Department of State is to investigate complaints against providers other than facilities such as individual physicians.
For patients, the bottom line will be the impact on the quality of medical care. On one hand, will the implementation result in deterioration in quality of care by some providers? Much will depend on monitoring and enforcement of the provisions of the act to prevent the premature discharge of patients, a rise in re-admissions and under-reporting/ non-reporting of events.