BCBS plans phasing out pay for errors, 'never events'

The whole business of not paying for "complications" is going out of hand. What if the hospitals decide to transfer patients with "complications" from one hospital to another(patient enters with a ICD code that indicates problem on admission, so the insurance company will have to pay for this). I am really surprised that doctors have signed off on this sinister bill. Many so called "complications" cannot be prevented in all patients. In chronically ill people who are bedridden, they can bring the infection with them to he hospital and then get infected with it at simple trauma sites like IV entry, arterial lines etc. or just even in the post op period. How do you really prevent this? MRSA is no longer a hospital acquired problem. It is rampant in the community. So is C.difficile. Look out! Every nursing home patient in the next year will be assessed as having at least a grade II decubitus ulcer on admission to a hospital to beat this trap. Poorly reasearched punitive measures like this do not help the cause of sick people. Insurance companies need to gather their own data. They have been really lazy about prospective data collection to help patients. When it suits their cause they jump upon bright ideas such as this issue of "complications" to improve their bottomline.

Dr. Murali:  Yes, there's little doubt that when reimbursement schemes change, hospitals will change their behavior--and not necessarily in positive ways. I have little doubt that payors will need to change in how they enforce no-pay mandates over time, as they see what happens and whether that's desirable.

I was told that beginning 01/01/2008, Blue Cross Blue Shield of Oklahoma will no longer recognize surgical global periods. Meaning, a surgery that consists of a global of 90 days will not be referenced by BCBS. Therefore, postoperative visits will not have to be billed and reimbursement is allowed on E/M services in the "global period".

Considering this is unbelievable, I was needing this information in writing. Is the above information true? Is the information availabloe on the bcbsok.com website...and if so, where can I locate it? All help would be greatly appreciated. Thank you.

I would like to see the nurses and ancillary staffs reaction to not being paid for a non-event. Oh wait....thats illegal right? Mandatory work and no pay = slavery. Hey how come only the doctors face the true financial impact of this no-pay non event thing. Only physicians will not be paid to take care of these complications. Slavery 2008 style. Jeve