The Dying American Autopsy

Ben White is a staff writer for Brief Policy Perspectives and a first-year MPP student.

The rate of autopsies has drastically declined over the last five decades, an issue that has concerned our nation’s health care experts. To address declining autopsy rates, policy makers could take immediate action to encourage more autopsies before we lose this critical public good. 

Autopsies as a Medical Quality Assurance Tool

Autopsies serve as an important quality assurance tool for our nation’s health care providers. Not only are they a valuable tool for teaching and training new doctors, but they serve to highlight disparities between doctors’ diagnoses and actual causes of death. Studies have shown that even with today’s advanced medical diagnostic technology, doctors still misdiagnose the cause of death in up to 25 percent of patients. In up to 10 percent of cases, the misdiagnoses were considered to have a potential negative impact on patient survival and would have changed doctors’ initial care plans. Data from one study using autopsies indicate that as many as 40,500 Americans die in intensive care units each year with misdiagnoses. When genetic diseases are in play, a proper diagnosis of the cause of death can be critical to ensuring surviving family members at high risk of the same diseases are aware of available preventive medical options. America’s sinking autopsy rates have done no favors to healthcare providers in their efforts to promote preventative medicine.

Autopsies and the COVID-19 Pandemic

Quality assurance is not the only important benefit that autopsies offer. Autopsies provide vital information about disease progression, the effectiveness of treatments, and overall disease trends. This benefit has been particularly important amid the current COVID-19 global pandemic. Autopsies have helped doctors and scientists understand how the virus progresses and affects different parts of the body, and offered early insight into what treatments are effective at combatting the deadly disease. One can argue that if doctors had performed  autopsies more regularly, the deadly virus may have been identified sooner in the U.S..  

America’s declining rate of autopsies have left us at a severe disadvantage in understanding the true toll of the COVID-19 pandemic. CDC data estimates that from March 15 2020 to January 9th 2021, there were 460,000 more deaths in the United States than would be expected in a normal year. This number represents an additional 72,000 excess deaths that are not accounted for in the official COVID-19 death count for that same time period. These non COVID-19 related excess deaths have been attributed to a wide variety of other causes, but with so few autopsies being performed, we have no way of knowing whether these deaths were related to the virus or not.

The Decline of the Autopsy

Before 1970, 40-60% of patients who died in hospitals received an autopsy.  In 1970, The Joint Commission, the organization responsible for hospital accreditation, eliminated the requirement of a 20% autopsy rate for in-hospital deaths for hospitals to receive accreditation. In the years since this decision, we have seen drastic declines of autopsy rates. In recent years, less than 5% of hospital deaths are followed up with an autopsy.

In a move that has further contributed to our declining autopsy rates, in 2019 the Trump administration pushed through the Omnibus Burden Reduction (Conditions of Participation) Final Rule. This rule attempted to “cut through red tape” by eliminating redundant, or excessively burdensome regulations that affect hospitals and healthcare providers. A part of this rule eliminated the requirement for hospitals to “attempt to secure autopsies in cases of unusual death and of medical-legal and educational interest”. The Centers for Medicare and Medicaid Services (CMS) and the Trump administration argued that the autopsy requirement was redundant because states have their own autopsy regulations in place. However, the American Society for Clinical Pathology highlighted that only six states have laws requiring autopsies in the case of all unusual deaths.

Reviving the Autopsy

Autopsies provide a crucial social good, and policy makers should make concerted efforts to save this good before it disappears. Autopsies provide critical feedback for our healthcare providers, offer vital understanding of novel diseases, provide closure for families following the death of a loved one, and offer guidance for family members facing hereditary diseases. The first step towards reversing the declining rate of autopsies is to reinstate the CMS autopsy standards that were eliminated in the Omnibus Burden Reduction Rule. Other proposals to increase autopsy rates include Medicare reimbursement for providers for performing autopsies, and the reinstatement of minimum autopsy rates as a requirement for hospital accreditation. Autopsies are an essential component of our nation’s health and policy makers should consider all options to encourage a revival of this dying practice.

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