never events

AHA, AMA balk at CMS nonpayment proposals for never events

Anne Zieger — Thu, 04 Dec 2008 03:22:03 -0500

The American Medical Association and the American Hospital Association have come together to challenge CMS proposals that would ban Medicare payments when surgeons operate on the wrong patient, the wrong part of a patient or perform the wrong procedure. While such a rule might sound simple on the surface, the two groups are both arguing that it's not--that CMS will need to do a better job of defining what can be reimbursed and what can't be before it begins withholding funds.

The AMA, for example, argues that the agency shouldn't simply add broad restrictions to its National Coverage Determination process, but should instead, "develop a clear payment policy outlining the circumstances" under which providers would forfeit their payment.

The AHA, for its part, also contended that CMS should determine what costs or services associated with the surgery wouldn't be covered. The hospital group would also like to see CMS provide some help on how it plans to assign responsibility when these errors occur.

To learn more about the study:
- read this Modern Healthcare item

Leapfrog's never events policy has higher participation in 2008

Anne Zieger — Tue, 28 Oct 2008 10:04:46 -0400

As healthcare industry attention shifts to medical errors--particularly "never events" that increasingly aren't reimbursable by health insurers--healthcare organizations are adopting new, more structured ways of addressing these problems when they occur. One approach comes from the Leapfrog Group, whose policy for dealing with never events includes apologizing to families, publicly announcing errors, and trying to discover root causes, as well as not billing for anything related to such events.

Apparently, more and more hospitals are pledging to follow the Leapfrog Group's policy, based on this year's annual survey. Of the hospitals surveyed in 2008, 63 percent pledged to follow the policy, up from 52 percent in 2007. Hospitals that implemented the policy were also more likely to get a higher safe-practices score from Leapfrog, as well. Of course, it's hard to tell whether the policy caused the improvement, but safe practices are always a good thing, right?

To learn more about Leapfrog's survey:
- Read this Modern Healthcare piece (reg. req.)

Indiana hospitals see 24 percent more errors

Anne Zieger — Tue, 26 Aug 2008 13:09:36 -0400

While the absolute numbers are still small, they're moving in a questionable direction. The number of serious medical mistakes taking place in Indiana went up 24 percent last year, from 85 in 2006 to 105 in 2007, according to a new report from the state's Department of Health. The most common mistakes--accounting for 27 percent of errors---were cases where patients developed severe bed sores. Surgeries where sponges or other objects were left inside of patients ranked second, with 24 cases, and wrong-body-part surgeries were third with 23 occurrences, up from 11 such errors found in 2006.

About 18 percent, or 51 of the 291 health facilities reporting, disclosed at least one error for 2007. Hospitals accounted for 101 of the errors, and ambulatory surgery centers reported four.

To learn more about this report:
- read this Chicago Tribune piece

Related Articles:
SC Medicaid plans to stop paying for errors
Business say 'no pay' for major mistakes
PA hospitals won't charge for 'never events'
CIGNA stops paying for its list of never events

SC Medicaid plans to stop paying for errors

Anne Zieger — Mon, 25 Aug 2008 13:37:40 -0400

Another plan has joined the "no pay for errors" parade: This time, it's South Carolina's Medicaid program, which covers about 800,000 South Carolinians. Officials with the program say that they won't stop making such payments to hospitals right away, however, as they have some technical questions to address before stopping such payments. The South Carolina Hospital Association has already adopted principles encouraging hospitals not to bill for certain mistakes, but participation is voluntary.

In making such a decision, the South Carolina Medicaid plan is joining a growing list of its health plan peers, including the New York, Massachusetts and Pennsylvania Medicaid plans, Medicare, CIGNA, Aetna and a number of Blue Cross Blue Shield affiliates. Meanwhile, hospitals in nearly half of states have agreed not to bill for never events.

To learn more about this decision:
- read this piece from the Associated Press

Related Articles:
By 2008, Medicare won't pay for hospital errors
Business say 'no pay' for major mistakes
PA hospitals won't charge for 'never events'
CIGNA stops paying for its list of never events

Hospitals in nearly half of states won't bill for never events

Anne Zieger — Wed, 13 Aug 2008 14:49:52 -0400

A new analysis suggests that hospitals in almost half of U.S. states will no longer bill patients for serious medical errors, up sharply from the beginning of 2008. In February, an analysis by a news organization concluded that hospital associations in 11 states had asked members to waive payment for never events. Now, the number states with such policies in place is 23, according to research by MSNBC.com.

This trend, of course, has gained a great deal of momentum as hospitals and their trade groups have braced themselves for Medicare, and commercial health plans, to roll out no-pay rule for serious errors. Medicare will cease such payments as of October 1, while various commercial plans like Cigna, Aetna and a number of Blue Cross Blue Shield affiliates have set their own policies and schedules.

The next wave may come from Medicaid agencies, which CMS has urged to enact their own non-payment policies. To date, Massachusetts, New York and Pennsylvania have done so, but no one knows yet how many more will follow.

To learn more about this trend:
- read this MSNBC.com article

Related Articles:
By 2008, Medicare won't pay for hospital errors
WA hospitals won't charge for never events
MA hospitals forswear payment for preventable errors
Study: Wrong-site surgeries, close calls are common

IL Blue plan won't pay for errors

Anne Zieger — Fri, 08 Aug 2008 11:22:18 -0400

Blue Cross and Blue Shield of Illinois has become the latest Blue plan to roll out a policy banning payment for medical errors by hospitals. It's become one of several fellow Blue plans to announce such a policy in the wake of an announcement by the Blue Cross and Blue Shield Association last November that its affiliates would be introducing such rules. Plans in states including Texas, Massachusetts, Michigan and Rhode Island have already announced their participation in the initiative.

According to the health plan, it will work with hospitals to roll out the policy, but it hasn't yet defined which conditions and events will be addressed. More typically, health plans that make such an announcement have been modeling their policies after CMS's list of conditions and never events for which it won't reimburse. Never events, typically those named by the National Quality Forum, usually include wrong-side surgery or discharge of an infant to the wrong family.

This is part of a larger national movement emerging to support non-payment for never events and preventable conditions. For example, earlier this summer the trade group for California health insurers, the California Association of Health Plans, announced that it had passed a resolution in favor of no longer paying for CMS's list of never events, as well as three preventable mistakes.

To learn more about this trend:
- read this Modern Healthcare article (reg. req.)

Related Articles:
BCBS plans phasing out pay for errors, 'never events'
By 2008, Medicare won't pay for hospital errors
Aetna, WellPoint refuse payment for serious errors
WA hospitals won't charge for 'never events'

KS health plans won't pay for 'never events'

Anne Zieger — Mon, 04 Aug 2008 12:35:19 -0400

Kansas' largest health plans have announced that they will stop paying hospitals for avoidable complications from care, including the administration of wrong blood types and certain infections. This includes Wichita-based Preferred Health Systems, which will stop paying on Oct. 1. Preferred Health Systems patterned its payment policy after Medicare's, but added a few non-payment conditions of its own, including wrong-side and wrong-part surgery and wrong-patient procedures. Meanwhile Blue Cross Blue Shield of Kansas, which will begin enforcing this policy on Jan. 1., followed up on its informal policy of refusing such payments.

The plans' decisions come on the heels of a recent announcement by Medicare that it was expanding its own list of "no pay" conditions, bringing the total of no-pay events to 11. Observers expect to see many more health plans get on the bandwagon over the next few months, as Medicare gears up to enforce its rules starting Oct. 1.

To learn more about the health plans' decision:
- read this piece in The Wichita Eagle

Related Articles:
By 2008, Medicare won't pay for hospital errors
PA hospitals won't charge for 'never events'
Aetna, WellPoint refuse payment for serious errors
VT hospitals will stop billing for 'never events'

TX hospital group issues medical-error billing guidelines

Anne Zieger — Fri, 18 Jul 2008 10:29:40 -0400

Following the lead of individual hospitals and associations around the U.S., the Texas Hospital Association has developed a policy designed to help its member hospitals determine when not to bill for care related to serious medical mistakes. The group's five "guiding principles" include that the error or event must have been preventable, within the control of the hospital, the result of a mistake made within the hospital, result in significant harm, and have been defined clearly and precisely in advance of the incident. The Association also included nine examples of non-payment events, including wrong-body-part surgery, wrong surgical procedure, infant discharged to the wrong patient, or patient death or disability due to a reaction to wrongly-used blood products. In creating this policy, the THA seems to be nudging health plans along, too. For example, Blue Cross and Blue Shield of Texas has already decided to base reimbursement on these principles.

To learn more about the policy:
- read this Modern Healthcare article (reg. req.)

Related Articles:
PA hospitals won't charge for 'never events'
NY Medicaid will stop paying for 'never events'
By 2008, Medicare won't pay for hospital errors
Businesses say: 'no pay' for major mistakes

CA hospitals disclose more than 1000 medical harm cases

Anne Zieger — Mon, 30 Jun 2008 10:18:33 -0400

California hospitals have made their first official disclosures of never events occurring in their facilities, a step required under a state law enacted in 2006. The disclosures, which cover the period between July 2007 and May 2008, address 28 never events specified in the legislation. The state's hospitals reported a total of 1,002 cases of serious medical harm, including wrong-organ surgeries, administration of incorrect drugs and neglect of serious medical conditions. This is a small percentage when weighed against the 4 million hospital admissions that occur in California each year, but still serious, observers note.

As in other states, California has considered legislation which would bar hospitals from charging patients for care that led to medical harm. Originally, such legislation would have covered all 28 conditions tracked by the state, but at the urging of hospital and physician lobbies, the legislator behind the proposed ban has cut back on what errors would be barred from charges.

To learn more about the error reports:
- read this Los Angeles Times piece

Related Articles:
NY Medicaid will stop paying for 'never events'
By 2008, Medicare won't pay for hospital errors
Businesses say: 'no pay' for major mistakes
PA hospitals won't charge for 'never events'

RI passes bill for patient safety committee, error-tracking system

Abby Christopher — Mon, 23 Jun 2008 15:17:54 -0400

Rhode Island lawmakers have passed legislation that would create a database for voluntary tracking of medical errors by healthcare providers and insurers. The bill, which still requires the governor's signature, would also establish a 14-member care advisory committee to review database findings and create quality improvement strategies. The patient safety group including the database would be a public/private partnership funded by annual fees paid by hospitals, nursing homes, health insurers and reporting agencies. Annual costs for running the group are estimated at just under $600,000. State and federal agencies would not be required to contribute annual fees.

In anticipation of the Centers for Medicare and Medicaid's "never events" policy that goes into effect later this year, Rhode Island joins a growing number of states--including Minnesota, Washington, Oregon, Massachusetts--and carriers including Blue Cross-Blue Shield that have adopted strategies to track and prevent medical errors.

Patient safety organizations also are growing beyond the borders of the United States. This Wednesday, the World Health Organization will formally launch its own a patient safety strategy designed to prevent medical errors.

For more:
- read the Modern Healthcare article
- glance at WHO initiative information