Update, Nov. 23, 2024: This story has been updated with information about President-elect Donald Trump’s Health and Human Services nominees and the correct date of this summer’s assassination attempt on Trump.
When the Leapfrog Group issued its latest patient safety scores, I looked up the hospital to which Donald Trump was rushed bleeding after an assassination attempt in western Pennsylvania this past summer.
The now-president-elect was lucky in more ways than the obvious — that a high-powered rifle bullet barely missed his head. Butler Memorial Hospital, from which Trump was discharged safely late on the night of July 13, has a long history of above-average patient safety performance. Luck, though, should have nothing to do with avoiding treatment-caused harm.
Ensuring consistently safe care at every hospital nationwide should be a conscious Trump Administration policy choice. Proposed nominees for key Department of Health and Human Services posts provide cautious optimism that it will be.
Patient safety came to the policy fore almost exactly 25 years ago. During the slow news period after Thanksgiving 1999, the Institute of Medicine issued a report declaring that 44,000 to 98,000 Americans were being killed every year by preventable medical errors in hospitals. The errors also added financial costs of $17 billion to $29 billion. Subsequent research has moved the death toll much higher, with Leapfrog estimating 160,000 avoidable deaths in hospitals in 2018, or more than three times the number of people who died in motor vehicle accidents.
Butler Memorial has regularly earned an “A” on the Leapfrog biannual report card, though it received a “B” in its spring 2024 and recent fall 2024 reports. Still, while the hospital fell short in some areas, it fully achieved the Leapfrog standard in “effective leadership to prevent errors.” That category includes providing resources to implement a patient safety program and developing “systems and structures to support action to improve patient safety.”
Harm Prevention Funding Falters Badly
That systemic attention to harm prevention is where health policy comes in. The initial report by the Institute of Medicine (today known as the National Academy of Medicine) sparked a public outcry. In response, Congress provided $50 million to what is now the Agency for Healthcare Research and Quality. Since then, though, patient safety funding has failed to even match inflation, much less reflect the pervasiveness of preventable harm repeatedly documented by researchers. For instance, a 2015 National Academy of Medicine report said it’s “likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences.”
In fiscal 2024, the AHRQ patient safety office budget was $89.6 million, with the same amount requested by the president for fiscal 2025. To put that into perspective, that modest funding doesn’t even equal half the net patient revenue of one average hospital. AHRQ’s total fiscal 2025 budget request was $513 million for all its activities, which include providing data and analytics to policymakers and research in digital health, primary care and behavioral health. Again, in perspective that’s about the sales of a couple of Costco warehouses as the total amount allocated to research on improving the safety and effectiveness of a nearly $5 trillion health care system.
A political problem AHRQ faces on the funding front is that the ineffective or harmful care it helps avoid is invisible to the patients and families who benefit. The Leapfrog Group estimated that 50,000 lives could be saved each year if all U.S. hospitals earned an “A” patient safety score, but it takes some digging to understand how far the public perception of safe care deviates from the reality. When you look at the list of the 12 hospitals that have received an “A” from Leapfrog every year since the first scores were given out in 2012, the most famous names in American medicine are conspicuously absent. For instance, there’s the Mayo Clinic in Phoenix, but not the renowned home clinic in Minnesota; a Kaiser Permanente outpost in Orange County, but none in its headquarters area of Oakland or in Los Angeles; and there are no Harvard hospitals on the list in Massachusetts.
While the Trump assassination attempt was dramatic, the more subtle health policy lesson was that none of us — president, presidential candidate or billionaire — can guarantee where we’ll be if we suddenly need medical care. Therefore, it’s vital that certain standards be upheld everywhere. Yet since 2012, as I’ve written, House Republicans have been trying to eliminate AHRQ altogether, mostly, it seems, because the agency represented an easy target for budget-cutters. Unfortunately, it’s a classic example of penny-wise and pound-foolish.
In his book Savings Lives & Saving Money: Transforming Health and Healthcare, the former GOP House Speaker Newt Gingrich — a former member of the AHRQ National Advisory Council, where I’m a current member — emphasized the importance of individuals “having access to quality, outcomes-based information.” As an individual, I couldn’t agree more. Policymakers, though, also need that same kind of information.
In late 2023, the Department of Health and Human Services launched a National Action Alliance for Patient and Workforce Safety, coordinated by AHRQ. The Trump administration’s HHS designees are uniquely equipped to build upon and accelerate that effort. Dr. Martin Makary, to be nominated to head the Food and Drug Administration, is a respected patient safety expert, having written that medical error is “the third leading cause of death” and called for greater transparency about hospital performance. Dr. Mehmet Oz, asked to head the Centers for Medicare & Medicaid Services, has surely seen his share of patient safety problems as a former heart surgeon at a major academic medical center. Meanwhile, Robert F. Kennedy Jr., nominated as HHS Secretary, suffered a well-publicized diagnostic error, almost undergoing unnecessary surgery for a putative brain tumor until a second physician examined the images and determined his symptoms were caused by a parasite that had infiltrated into his brain and then died.
The “zero harm” experience of Donald Trump; the professional expertise of Makary and Oz; and the medical error suffered by Kennedy should motivate the new administration to put funding and political clout behind a demand that hospitals with the “systems and structures to support action to improve patient safety,” as was the case at Butler Memorial, should be the minimum every American can expect.