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Medical Insurers Focus on ‘Never Events’

July 17, 2008

By Alan Bavley, The Kansas City Star, Mo.

Jul. 17–That sponge left inside you after surgery. That urinary tract infection from a catheter. Those bedsores during a long hospital stay.

Blue Cross and Blue Shield of Kansas City has been paying hospitals to treat serious and often avoidable complications like these.

Come Oct. 1, that is going to stop.

The halt in payments is designed as an incentive to hospitals to be meticulous about following safety guidelines — from frequent hand-washing to taking careful inventory of surgical objects.

“It’s all about patient safety,” said Blue Cross spokeswoman Susan Johnson. “We’re not putting this in play because we’re seeing large numbers of complications. But obviously, we are human and (adverse) medical events can happen.”

Blue Cross is following the lead of Medicare, which announced last summer that on Oct. 1 it would stop paying hospitals for treating complications caused by the same list of avoidable conditions. The list includes:

–Objects left inside a patient during surgery.

–Use of the wrong blood type during transfusions.

–Urinary tract infections associated with a catheter.

–Bedsores.

–Air embolism (a sudden artery blockage caused by air bubbles introduced during surgery).

–Hospital-related injuries such as fractures, dislocations, head injuries and burns.

–Severe chest infections after surgery.

–Blood infections from a catheter.

The payment cuts for hospital complications are among the latest actions in a decade-old movement to save patient lives by preventing avoidable medical mistakes.

A 1999 Institute of Medicine report projected that medical errors, particularly those at hospitals, could be causing 98,000 deaths per year.

The Centers for Disease Control and Prevention had estimated that as many as 2 million patients a year pick up infections at hospitals.

The BlueCross BlueShield Association, which represents Kansas City Blue Cross and several dozen other Blues, announced in November that its member plans would work toward ending hospital payment for these kinds of mistakes, which are often referred to as “never events.”

Other insurers also have announced they would stop paying for even longer lists of never events, including surgery on the wrong side or body part, medication errors, or the death or disability of a mother during delivery in a low-risk pregnancy.

Aetna and WellPoint have started adding never-event provisions to some contracts, and in April, CIGNA HealthCare announced it would do the same.

Meanwhile, hospitals in Massachusetts and Minnesota have announced that they would no longer charge for complications caused by preventable errors.

In the Kansas City area, six hospitals and hospital groups have reached an agreement with Blue Cross on its initiative. They include St. Luke’s Health System, HCA-Midwest Division, the University of Kansas Hospital, North Kansas City Hospital, Truman Medical Centers and Children’s Mercy Hospitals.

The hospitals also have agreed not to charge patients for the cost of treating such complications. Payments to doctors are not affected.

Johnson said Blue Cross expects all hospitals in its network to sign the agreement by Oct. 1.

Medicare estimates a savings of $20 million the first year. Annual savings would increase to $50 million if Medicare follows through with its plan to add nine more preventable conditions next year.

That may seem like a drop in the bucket for an agency that spends billions, but the estimate does not take into account the potential savings in medications, doctors fees, rehabilitation costs and other expenses of treating preventable complications, Medicare officials say.

Blue Cross also does not expect to see significant savings by not paying for preventable complications.

“It’s nominal,” said Johnson. “But it’s not about money. It’s what’s best for the patient.”

To reach Alan Bavley, call 816-234-4858 or send e-mail to abavley@kcstar.com.

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Copyright (c) 2008, The Kansas City Star, Mo.

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