“First do no harm.” The Hippocratic Oath is a solemn ethics pledge historically taken by physicians. It requires a new physician to swear to uphold specific ethical standards, most notably by ensuring patient safety. It is an oath that is the bedrock of appropriate medical care.
In Governor Hochul’s executive budget, tens of billions of dollars will be spent on health care. Health care groups have argued that the governor’s plan is simply not enough to cover the costs of programs, most notably Medicaid.
Yet, too little attention has been devoted to the quality of the medical care that the state, employers, and individuals pay for. There is considerable evidence that the quality of hospital care is too often substandard, and therefore it must be a priority of lawmakers to ensure that steps are taken to address the uneven quality of care as part of any final budget agreement.
Poorer quality of care can drive higher expenses. A key measure in assessing the quality of hospital care, for example, is “readmission” rates. Research from the Agency for Healthcare Research and Quality (AHRQ) shows that hospital readmission costs were higher than initial admission costs for about two-thirds of common diagnoses in 2016. Thus, appropriately reducing hospital readmissions not only provides better care, but is less costly.
The costs of substandard care are well-documented. In November 1999 the Institute of Medicine report, To Err is Human: Building a Safer Health System, was released. It documented an epidemic of preventable deaths in United States hospitals. In September 2009, the director of the U.S. Agency for Healthcare Research and Quality, wrote this about To Err Is Human: “Let me be clear: I am just as frustrated as my colleagues in the public and private sectors with our slow rate of progress in preventing and reducing medical errors.” A widely-covered study published in 2023 reported that 400,000 U.S. hospital patients experienced some type of preventable harm each year.
The costs resulting from these patient injuries and deaths are enormous. According to one estimate, the annual cost of measurable medical errors that harm patients was $20 billion. Since New York State is approximately 6 percent of the nation’s population––and if the quality of care were universally distributed (which it is not) — the state’s additional costs could be roughly $1 billion. However, there is compelling evidence that the quality of health care in New York is worse than the rest of the nation.
The U.S. Department of Health and Human Services annually publishes Medicare.gov/Compare, which reports the quality of the nation’s hospitals and other providers to the public. Researchers use that information to compare states. One organization, the “Leapfrog Group” (established by the nation’s large employers in 2000 in order to measure “hospital performance, empowering purchasers to find the highest-value care and giving consumers the lifesaving information they need to make informed decisions”) has issued annual reports on the quality of American hospital care for over 20 years. Over those two decades New York has been consistently ranked poorly.
This past year’s Leapfrog Group report found that New York State ranked 42nd nationwide in terms of quality, with only 11.3 percent of hospitals receiving an “A” grade.
Why do New York hospitals perform comparatively so much worse? In July 2019 the director of Leapfrog Group explained what she knew about New York’s hospital safety:
“The system as a whole didn’t seem to have emphasized safety. We’ve seen other states work together and look at what’s working well at other states and implement it. It just doesn’t seem to be happening in New York.”
This week, state lawmakers will hold a hearing on the governor’s proposed health budget. New York hospitals’ consistent poor performance should be a top line of inquiry. Here are some questions that lawmakers should be asking of the state’s regulator of hospital safety, the New York State Department of Health:
- Why did New York State hospitals rank so poorly?
- What has the New York Department of Health done to respond to the national rankings that have consistently found poor quality in state hospitals?
- What progress has New York State made in meeting its goal to reduce by half New York’s hospital patients’ injuries and deaths, a promise made 20 years ago?
When we go to the hospital, we should all expect that all is being done to make us better, not worse. It seems too often clear that isn’t happening in New York. State lawmakers should use the budget process to get to the bottom of why New York’s hospitals are falling short of the oath to “first do no harm.”