Insurers could play a key role in ensuring patient safety


Patient safety is a concept that has a high "buzz" value, but healthcare providers sometimes falter turning the ideal into an on-the-ground reality. Practically all of the 200-plus hospital executives participating in a recent survey by L.E.K. Consulting LLC in Boston expected to maintain their patient safety budgets in the face of ongoing budgetary pressures, and more than one-third of respondents planned to increase spending by 10 percent or more to reduce errors and infection rates. Yet despite this ongoing focus, patient safety incidents at U.S. hospitals accounted for the deaths of almost 100,000 Medicare beneficiaries from 2006 to 2008, costing taxpayers $8.9 billion according to a report from HealthGrades, the Golden, Colo.-based independent national healthcare rating organization.

Sure, many hospitals are making great strides toward setting benchmarks in patient safety. Augusta Health in Fishersville, Va., recently received the Patient Safety Excellence Award from HealthGrades. Award winners are 43 percent less likely to have patient safety mishaps than most hospitals.

But all you have to do is Google "patient safety" or the like to find at least one headline-making incident that drives home this point: Not all hospitals are measuring up. "If all U.S. hospitals had performed at the same level as the Patient Safety Excellence Award hospitals, the U.S. healthcare system could have saved nearly $2.1 billion and potentially prevented 22,590 deaths in just three years among Medicare cases alone," says HealthGrades.

The passage of the Patient Protection and Affordable Care Act (PPACA) could push health plans to become a driving force in promoting patient safety for their members. The new law requires insurers to incorporate quality improvement (QI) efforts in contracts with hospitals and other healthcare providers by 2012. QI efforts include actions to reduce hospital readmissions and improve patient safety using health information technology, evidence-based medicine and other best practices. In addition insurers will have to provide annual reports on these efforts to policyholders and the Secretary of the Department of Health and Human Services.

Effective January 2015, the PPACA also requires insurers that participate in the health benefit exchanges to contract only with hospitals that have instituted a comprehensive program to ensure patient safety and proper discharges. (Small hospitals will be excluded from the requirement.) The HHS Secretary will develop contract-based quality requirements for other healthcare providers, such as physicians. Also, the health exchanges will create and publish a rating system for health plans based on quality and price.

Health plans such as Anthem Blue Cross and Blue Shield in New Hampshire and Blue Cross Blue Shield of Michigan have been instituting pay-for-performance programs for several years. But the PPACA is the first national mandate to incorporate quality requirements into provider-payer contracts.

Will these new rules generate awkward, time-consuming reams of paper-based compliance? Well, we are dealing with the government, so there is bound to be paper involved. However, that doesn't mean compliance should be a pencil-pushing activity.

Payers and healthcare providers can use this mandate as an opportunity to collaborate and drive true change so that they can make patient safety the core tenet of the healthcare system that it should, by rights, be already. By fulfilling the spirit of the Patient Protection Act, payers can take the physician's maxim, "First, do no harm," and make it their own to protect plan members on a consistent basis. - Caralyn

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