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Rep. Miller-Meeks Pushes for Hospital Transparency but Warns of ‘Adverse Effects’



Representative Mariannette Miller-Meeks is a believer in hospital transparency but says relying on ratings could potentially prompt the closure of hospitals in rural areas and give hospitals an incentive to not admit certain types of patients.

A recent study from the Yale School of Medicine found there are about 22,000 preventable deaths of hospitalized patients each year in the United States. A preventable death includes developing a clot in a patient’s leg, a patient receiving the wrong medication or an amputation of the wrong leg.

In an interview published April 2, Miller-Meeks, an Iowa Republican, told A Starting Point (ASP), a civic media organization, the government has a role to play in mandating what information hospitals release to the public. While that can be beneficial, Meeks warned of the “detrimental” effects of data on preventable deaths, particularly on patient care and hospitals.

“The worst thing is then for hospitals, especially in rural areas, to end up closing down because their score is different, but you’re not putting into it all of the factors that go into that score or transparency data,” Miller-Meeks said.

Before joining Congress, Miller-Meeks served as a physician and a nurse in the Army and served as the Iowa director of public health. She pointed to the Yale study as evidence that care needs to be taken when reporting on preventable deaths.

Patients rest in a hallway in the overloaded emergency room area at Providence St. Mary Medical Center in Apple Valley, California, on January 27.
Mario Tama/Getty Images

Yale’s study found that hospital preventable deaths were two to four times lower than previous estimates. An often-cited landmark 1999 study by the Institute of Medicine found there were 44,000 to 98,000 preventable deaths, and other studies put the death toll as high as 250,000.

Benjamin Rodwin, an assistant professor of internal medicine at Yale and a corresponding author for the study, said the reason for the discrepancy is how the calculation is made. The 1999 project looked at patients admitted to a hospital with an adverse event, including an incorrect diagnosis or therapy delay, and then how many of those errors led to the patient’s death. The Yale study took the hospital deaths and worked backward to determine whether they were preventable.

To help prevent some of those deaths, Representative Raul Ruiz of California, an emergency physician, told ASP that providing standards of care is important. That gives patients the knowledge that accredited hospitals have systems in place to ensure certain precautions are being taken, such as “time-outs” where medical professionals can discuss the procedure so they’re “all on the same page.”

Ruiz also noted that in a situation where there is mandatory reporting, there also needs to be protections and privacy for physicians and the hospitals.

In the ASP interview, Miller-Meeks advocated for a uniform way of identifying preventable deaths that uses the same metrics and language to identify what really constitutes a hospital preventable death. Without that, one hospital could be reporting deaths that are either much higher or lower than another hospital because of the language and metrics being used.

Another “adverse effect” of relying on scores and ratings for hospital transparency is that a person is judging a hospital based on a metric that isn’t necessarily providing a full picture of what goes into the score, Miller-Meeks said. It also has the potential to incentivize hospitals to accept only certain patients.

“Does that skew a hospital to not admit certain kinds of patients or patients with certain severity of diseases so that their ratings or their numbers are better?” Miller-Meeks asked. “So then you end up having this adverse effect that you didn’t intend.”

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