State governments, private payors, Medicare, and hospitals have reached the same conclusion: Hospitals should not charge for preventable medical errors.
One of the latest entities to join this trend is Washington state. Early this year, healthcare associations there passed a resolution saying Washington healthcare providers no longer will charge for preventable hospital errors. The resolution applies to 28 “never events” published by the National Quality Forum (NQF). These are medical errors that clearly are identifiable, preventable, serious in their consequences for patients, and indicative of a real problem in the safety and credibility of a healthcare facility. (For a complete list of events, visit NQF’s Web site (www.qualityforum.org/pdf/news/prSeriousReportableEvents10-15-06.pdf).
Hospitals in Massachusetts, Minnesota, Pennsylvania, and Vermont have adopted similar policies. Private insurers Aetna, Wellpoint, and Blue Cross Blue Shield each are taking steps toward refusing payment for treatment resulting from serious medical errors in hospitals.
Amid these decisions, the American Hospital Association (AHA) released a quality advisory Feb. 12, recommending hospitals implement a no-charge policy for serious adverse errors.
“There’s certainly been a lot of conversation about aligning payment around outcomes,” says Nancy E. Foster, the AHA’s vice president for quality and patient safety policy. “Most of those conversations have focused on reward for doing the right thing, but there were certainly parts of those conversations based on the notion of who’s responsible and who pays when something that was preventable did happen.”
Even the federal government has gotten involved. Beginning in October, the Centers for Medicare and Medicaid Services (CMS) plans to no longer reimburse for specific preventable conditions.
CMS “Stop Payments”
If Congress approves Medicare’s plan, the CMS will not pay any extra-care costs for eight conditions unless they were present upon admission—and it prohibits hospitals from charging patients for such conditions. The conditions include three “never events”:
- Objects left in the body during surgery (“never event”);
- Air embolism (“never event”);
- Blood incompatibility (“never event”);
- Catheter-associated urinary tract infections;
- Pressure ulcers (decubitus ulcers);
- Vascular catheter-associated infection; and
- Surgical site infection after coronary artery bypass graft surgery (mediastinitis).