Beginning October, Medicare will not pay for treatment resulting from several types of hospital errors the agency considers preventable, nor will hospitals be able to bill the patients for the care. As private payors, state governments and Medicare tighten their belts, pay-for-performance programs have gained favor; popular opinion has shifted to the belief that a hospital should incur the financial burden when these errors occur.
The most serious preventable events — what the National Quality Forum calls never events — are
- an object mistakenly left in a patient during surgery,
- a preventable air embolism,
- complications from being given incompatible blood,
- catheter-associated urinary-tract infections,
- pressure ulcers (bedsores),
- a vascular catheter-associated infection,
- a surgical site infection after coronary-artery-bypass graft surgery, and
- patient falls.
Although these new conditions were included in the acute care hospital Inpatient Prospective Payment System (downloadable as PDF or text) final rule for fiscal year 2008, published in August, and were first introduced in the Deficit Reduction Act of 2005, it is likely patients will start hearing more about the reimbursement change — and asking questions of providers — as the October implementation date comes closer.
In some non-government-payor cases, implementation is already here. Insurers including Aetna and Blue Cross and Blue Shield are modifying their contracts to stipulate they will not cover hospital errors. According to the Leapfrog Group, a consumer healthcare advocate, Pennsylvania recently joined Minnesota and Massachusetts as states that would stop Medicaid payments to cover errors. Further, more than half of hospitals surveyed by the group agreed to not bill for never events as of September 2007.
“Through the Leapfrog Hospital Quality and Safety Survey, we give public recognition to hospitals that are willing to take all the right steps in the rare instance that a never event occurs in their facility,” said Suzanne Delbanco, CEO of the Leapfrog Group in a press release. “The hospitals who agree to our never events policy are also helping us to pioneer ways to tie payments for care to quality.”
