9:48am

Thu December 15, 2011
Shots - Health Blog

Once Routine, Autopsies Now Scarce At U.S. Hospitals

When a loved one dies unexpectedly in the hospital, getting answers to how and why isn't as easy as it was 50 years ago.

Back then, doctors would often order a clinical autopsy. But an investigation published today by ProPublica shows that hospital autopsies have become a rarity:

"A half-century ago, an autopsy would have been routine. Autopsies, sometimes called the ultimate medical audit, were an integral part of American health care, performed on roughly half of all patients who died in hospitals. Today, data from the Centers for Disease Control and Prevention show, they are conducted on about 5 percent of such patients."

The findings are part of Post Mortem, a reporting partnership by NPR News Investigations, ProPublica and PBS Frontline, about deep flaws in the U.S. death investigation system.

Over the past year, the series has uncovered the lack of skilled forensic pathologists who can perform autopsies, wrongful convictions among child death cases, and disputes among the medical and legal communities.

Today's ProPublica report details "hospitals' powerful financial incentives to avoid autopsies" and explains that without information from these procedures, diagnostic errors are often missed. This gap not only leads to lost opportunities for improved medical treatment, but skews health care statistics.

The report continues:

"An autopsy costs about $1,275, according to a survey of hospitals in eight states. But Medicare and private insurers don't pay for them directly, typically limiting reimbursement to procedures used to diagnose and treat the living. Medicare bundles payments for autopsies into overall payments to hospitals for quality assurance, increasing the incentive to skip them, said Dr. John Sinard, director of autopsy service for the Yale University School of Medicine.

'The hospital is going to get the money whether they do the autopsy or not, so the autopsy just becomes an expense,' Sinard said.

Since a 1971 decision by The Joint Commission, which accredits health-care facilities, hospitals haven't had to conduct autopsies to remain in good standing. The commission had mandated autopsy rates of 20 percent for community hospitals and 25 percent for teaching facilities, but dropped the requirement. Many hospitals were performing autopsies 'simply to meet the numbers' and not to improve quality, said Dr. Paul Schyve, the commission's senior adviser of health-care improvement. Doctors, too, have gravitated away from autopsies because of growing confidence in modern diagnostic tools such as CT scans and MRIs, which can identify ailments while patients are still alive.

Still, in study after study, autopsies have revealed that doctors make a high rate of diagnostic errors even with increasingly sophisticated imaging equipment."

Continue reading more of the investigation, including the story of how one woman spent eight years trying to find answers to her husband's death.

Previously on Shots, Kaiser Health News' Michelle Andrews reported that while most hospitals have drastically reduce the number of autopsies they perform, a family that requests one can sometimes get it free of charge.

Copyright 2013 NPR. To see more, visit http://www.npr.org/.