When the Leapfrog Group issued its latest patient safety scores, I decided to look up Butler Memorial Hospital, the Pennsylvania facility to which Donald Trump was rushed after an assassination attempt at a nearby rally.
The now-president-elect was lucky in more ways than the obvious one; i.e., that the would-be assassin’s bullet barely missed his head. Butler, from which Trump was discharged safely late on the night of July 23, has a long history of above-average patient safety performance. Luck, though, should have nothing to do with it: ensuring consistent patient safety among hospitals nationwide should be a conscious Trump administration health policy choice.
Patient safety came to the policy fore almost exactly 25 years ago. During the slow news days 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 frequency of 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 3 times the number of people who died in motor vehicle accidents.
Butler 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.” The category includes providing resources to implement a patient safety program and developing “systems and structures to support action to improve patient safety.”
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 keep up with inflation, much less reflect the pervasiveness of preventable harm steadily 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 equal even 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. To again provide some perspective, that’s a dollar amount equal to the sales of a couple of Costco warehouses allocated to the task of improving the safety and effectiveness of our nearly $5 trillion health care system.
A political problem AHRQ faces on the funding front is that ineffective or harmful care that’s avoided 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. 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, its less-obvious health policy lesson is that none of us – a president, presidential candidate or billionaire – can guarantee where we’ll be if we suddenly need medical care. As a result, 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, need that same kind of information, too.
In late 2023, the Department of Health and Human Services launched a voluntary National Action Alliance for Patient and Workforce Safety. The new HHS secretary should continue and ramp up that effort. The “zero harm” experience of Donald Trump at Butler Memorial – a place with the “systems and structures to support action to improve patient safety” – should be the expectation of every hospital in America for every one of us.
