Vanessa Fuhrmans of the Wall Street Journal reports that insurance companies are probably going to stop paying for medical treatments made necessary by “never-events,” (list from the National Quality Forum) those major screw-ups you pray a hospital never commits. Examples include leaving a sponge in a surgery patient, amputating the wrong limb, transfusing the wrong blood type, etc. Participating insurers are following Medicare’s lead, and not allowing themselves, or patients to be billed for errors that should, under no circumstances, occur. Some of these insurers are WellPoint, Aetna, Cigna, UnitedHealthcare, and Humana.
The purpose is to incent hospitals to prevent these mistakes in the first place, which cost billions a year to insurers, hospitals and patients alike. Laissezfairehealthcare is in favor of this. Eventually more preventable errors that aren’t necessarily never-events, will become never-events as hospitals become safer and less accident-prone. While hospitals could spend money trying to skirt around these new restrictions, or attempt to pass the cost through to the insurers and patients another way, many will discover simple updates in policies and procedures, personel changes, or technological investments will more than pay for themselves in improved patient outcomes.
Smart hospital administrators are already seeing the light: “[t]o lower its rate of infection…Pitt County Memorial Hospital in Greenville, N.C., in February expanded its screening for methicillin-resistant staph infections to all patients coming into the hospital. By identifying and isolating those with the strain early, it lowered the number of MRSA pneumonia cases related to ventilator use by 67% and MRSA urinary-tract infections by 60% within eight months. In all, the expanded screening has cost nearly $1 million, $800,000 picked up by private and public insurers. Steve Lawler, the hospital’s president, says it has more than recouped its $200,000 investment. Moreover, spending the money to make the hospital safer is a “better return on investment…than some billboard campaign,” he says.”
For another viewpoint - visit to the Verden Group’s blog.
As a registered nurse working in a large urban teaching hospital I’d like to comment on the 1/15/08 article that appeared in the Wall Street Journal regarding insurance companies no longer assuming the costs for preventable errors in hospitalized patients. With today’s emphasis on educating the consumer and soaring healthcare costs it was inevitable that sooner or later someone, the Federal government or the insurance companies, would devise a plan to control their costs. It is a fact of life today as a healthcare provider/organization that you either “adapt or die”. Change is always difficult and constant change is overwhelming and often has the effect of desensitizing the healthcare professional. I choose to reframe the issue and see it as advocating for best practice outcomes in patient care and not as an overall attack against the healthcare industry. There are some areas in healthcare that we should be more proactive in preventing! In order to do that we need to constantly think outside the box and be vigilant in keeping one step ahead by staying current in the latest trends and research, becoming involved in advocating for patient safety. We need to promote and encourage organizations to trial new products as they arrive on the market such as the Vivax Mobility System and the Soma Safe Enclosure Bed. Both are manufactured by the Vivax Medical Corporation. The Soma Safe Enclosure Bed helps prevent patient injuries from falls and wandering, two of the items on the list that are non-reimbursable. It took my organization eighteen months to finally implement the Soma Safe Enclosure Bed and another six months to get the staff to utilize it. Once it took hold it has been a win-win situation for staff and patients alike. The same hold true for the Vivax Mobility System as a means to get patients up and help to decrease the incidence of decubitus ulcers, catheter infections and pneumonia. Change is difficult and we must learn to embrace it if we are to stay viable! My last point is in regards to what Michael Maves, executive vice president of the American Medical Association, said in his letter to CMS. I too share a concern that we as an industry will be penalized for “complications that are a biological inevitability”. My belief and hope is that the Federal government and the insurance companies will continue to offer the healthcare industry “due process” in the form of case review and the denial appeals process as a means tease out what is truly preventable and what is inevitable. If this cannot be sufficiently accomplished then I fear that the patients in greatest need will be discriminated against and patient centered care and improved patient outcomes will become a pipedream.