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Artificial intelligence (AI) is currently used to assist with many healthcare practices, including diagnosing cancer, detecting deterioration, and medication reconciliations. As the use of AI continues to expand, regulators and legal experts will need to consider how to manage compensation for patients who have experienced medical errors. This commentary suggests no-fault compensation as a possible solution. 

Newly diagnosed cancer patients may request second opinions to confirm diagnosis, treatment, or prognosis. This study evaluated the pathology-specific reimbursement for cases originating at the primary site, a comprehensive cancer center, and cases originating at affiliate sites and referred to the cancer center for second opinions. Results confirmed that second opinions can reduce diagnostic errors and potentially lower costs of subsequent treatment; however, ways to improve the cost and process of receiving a second opinion should be explored.

Quality measurement is increasingly being incorporated into policies outlining healthcare provider reimbursement. This study compared quality measure calculations between an individual electronic health record (EHR) source and the same EHR source combined with health information exchange (HIE) data. The results show that adding HIE data changed 15% of quality measure calculations. The authors suggest that incorporating HIE data into reimbursement programs could promote more accurate and representative quality measurement.

Since 2014, Medicare’s Hospital-Acquired Condition Reduction Program (HACRP) reduces payments to hospitals with elevated rates of certain conditions. Based on multistate data, the authors conclude that there is a disconnect between penalties levied by the program and hospital performance, suggesting that the program may not drive patient safety improvements as intended.  

This study used national data to explore whether financial integration affects healthcare quality and safety and found that hospital-physician financial integration did not influence adverse event rates. 

Since 2013, Medicare’s Hospital-Acquired Condition Reduction Program (HACRP) has reduced payments to hospitals with elevated rates of specific outcomes deemed to be preventable sources of harm. To better understand the impact of the HACRP in Michigan, this study used a surgical registry to compare trends in rates of outcomes targeted by the program to concurrent trends for other hospital-acquired conditions, such as postoperative cardiac arrest and postoperative pneumonia. The authors saw an overall decrease in all hospital-acquired conditions over the eight-year study period but did not identify a statistically significant change in the rate of HACRP-targeted versus non-targeted conditions. The authors acknowledge that these findings may not be generalizable nationally because of robust quality improvement efforts already in place in Michigan, such as existence of other quality improvement efforts, such as the AHRQ-recognized Michigan Surgical Quality Collaborative and the Hospital Engagement Network

The relationship between hospital financial performance and patient safety remains somewhat controversial. Although it makes intuitive sense that more financially stable hospitals should be able to invest more in improving safety, prior studies have not consistently confirmed this hypothesis. Investigators examined the relationship between financial performance and the safety and quality of care at 108 hospitals in New York State. They found that stronger financial performance was correlated with improved patient experience, lower readmission rates, and higher performance on measures of safety and quality. This finding has policy implications, as other studies have found that safety-net hospitals (which generally have lower financial margins) face more difficulties in responding to safety and quality regulations.

High-quality, reliable safe health care is a complex challenge. This commentary reviews estimates of health care–associated harm and injury to patients and the complexities associated with the Centers for Medicare and Medicaid Services financial penalties approach to drive improvement.

The Centers for Medicare and Medicaid Services impose financial penalties on hospitals whose Medicare patients experience higher rates of hospital-acquired conditions (HACs) like urinary tract infections and pneumonia. Hospitals caring for more patients with low socioeconomic status receive more penalties under this program than hospitals caring for wealthier populations. Investigators attempted to assess whether hospitals penalized under the program reduced HAC rates. They found that penalized hospitals did not have lower HAC rates or improve other measures of clinical quality. This finding raises questions about whether financial penalties effectively enhance patient safety. By contrast, quality improvement collaboratives like Partnership for Patients have markedly reduced HACs. A PSNet interview with former AHRQ director Andrew Bindman explored strategies for reducing health care–acquired harm in the hospital and ambulatory settings.

Health care is working to provide high-value care and prevent overuse while ensuring patient safety. This commentary highlights the importance of educational initiatives, mentors, and use of clinical decision support to help clinicians determine what amount of care is appropriate for a given clinical situation.

This pre–post study found that implementation of relative value unit–based payment in a head and neck surgery practice resulted in a higher volume of procedures. The incidence of adverse outcomes, including postoperative hospitalizations, infections, unplanned return surgeries, and emergency department visits, did not change. The authors conclude that the change in payment structure did not impact surgical safety.