Hearing of the Senate Health, Education, Labor and Pensions Committee - Crossing the Quality Chasm in Health Care

Hearing of the Senate Health, Education, Labor and Pensions Committee - Crossing the Quality Chasm in Health Care

(As Entered into the Record)

The United States spends more than $2 trillion a year on health care, yet the Institute of Medicine reports that as many as 98,000 Americans may die from medical errors each year, more people than die from breast cancer, AIDS, and motor vehicle accidents combined.

Despite the numerous and significant advances in medical science in recent decades, our health care system has fallen short in translating this new knowledge and technology into practice. On average, there is a 17-year time lag between the discovery of more effective treatments and their incorporation into routine patient care, and even when advances are finally included in clinical guidelines, there is no guarantee that patients will benefit. One study found that only 55% of patients receive care consistent with clinical recommendations, and less than half of Americans living with chronic conditions such as diabetes, asthma, and hypertension obtain disease management treatment according to the guidelines of medical practice. Furthermore, these gaps in quality disproportionately affect those most in need of care. The uninsured and racial and ethnic minorities are much more likely than other patients to receive sub-standard health care.

The overly complex and fragmented structure of our health care delivery system contributes to the lack of quality. Since our fee-for-service system does not reimburse for coordination among health care providers, omitted or duplicative procedures, delays in care, and medical errors are common. Less than 25% of providers use electronic medical records. We are losing countless opportunities for an efficient and reliable means of recording patient information and coordinating care.

The health consequences of poor-quality care are reason enough for urgent action, but the economic impact of medical errors and inefficiencies make a Call to Action even more urgent. Preventable medical errors cost between $17 and $29 billion dollars a year in lost income, lost productivity, disability, and additional health services needed. Medication-related errors in hospitals alone cost an estimated $2 billion each year.

Expanding insurance coverage alone will not solve this crisis. As past experience makes clear, it is perverse to hold out the promise to receive care, when that care is of poor quality, or even dangerous. The human and financial costs demand immediate attention.

Fortunately, innovations in system delivery provide several promising strategies for improving quality. We can establish standards of health care, so that all patients receive the services they need. We can improve the coordination of care, by modernizing Health Information Technology, as the economic stimulus package proposes to do, particularly in rural and underserved areas, and by using the medical home model and adding financial incentives for better communication among providers. The $1.1 billion in the stimulus for research in comparative effectiveness will help identify what works and what we have yet to learn.

It is essential that these initiatives be paired with coordinated efforts for the development, implementation, evaluation, and accountability of measures to enhance the quality of care. These measures must reflect best practices, patient outcomes, and quality of life. Many important organizations have begun work in this area, and they deserve our support in continuing and expanding this work.

We cannot continue to have a "siloed" health system and classes of care. I look forward to working closely with my Senate colleagues on the HELP and Finance Committees and President Obama to ensure that we improve access to care and make sure that it is high-quality, safe, and effective health care. I commend Senator Mikulski for her impressive leadership in this essential area of health reform, and I look forward to learning more from each of our witnesses today about this important issue.

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