Managed Healthcare Executive - November 2008 - (Page 23)

{ HOSPITALS AND PROVIDERS } Medical mistakes new caveat in contracting terms Insurers follow updated CMS rules regarding nancial responsibility for egregious medical mistakes BY DAVID BENNETT T David Bennett is senior editor in Advanstar Communications Inc.’s Centralized Content Group. 161,000 patients in employer-based health plans, insurers paid an additional $28,218, or 52% more for surgery patients who experienced acute respiratory failure. The study also says insurers paid an extra $19,480, or 48% more for surgery patients who developed post-operative infections. At the end of July, CMS added three more conditions—surgical site infections following certain elective procedures including some orthopedic surgeries and bariatric surgery for obesity; certain manifestations of poor control of blood sugar levels; and deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures—to its well-known list of eight never events that it will not pay for. Following CMS’s lead, major insurers are pursuing similar and sometimes more aggressive policies of nonpayment in reference to the expanded do-not-pay list. In January, Aetna announced that it wouldn’t pay for any of the 28 never events, as identi ed by the National Quality Forum. WellPoint has introduced a HERE WAS A TIME IN WHICH TRUE similar program. UnitedHealthcare and medical mistakes, such as removing the wrong all 39 Blue Cross and Blue Shield plans kidney, received little attention outside of the are also considering restrictions. operating suite. That time has run out. Going further, however, Aetna also Since Medicare’s announcement that it will no is pushing hospitals to embrace quallonger pay for certain preventable errors begin- ity patient care measures as part of ning last month, hospitals and providers are mov- contracting. ing quickly to reduce costly errors that not only risk The insurer already requires hospitals life and limb, but present a nancial burden. A new to waive patient bills when certain medireport from the Agency for Healthcare Research cal errors occur and to apologize to famiand Quality (AHRQ) determined that potentially lies of the patients hurt by the mistakes. preventable medical errors that occur during or after Aetna reports that since the beginning surgery cost employers nearly $1.5 billion a year. of the year, one in three hospitals with Based on a nationwide sample of more than which it has negotiated either a new or NOVEMBER 2008 ERproductions Ltd/Getty Imges 23

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Managed Healthcare Executive - November 2008 For Your Benefit Editorial Advisors Contents News Analysis State Report Politics &�Policy Letter of the Law Affordable Access Economic Ripple Effect Hospitals &�Providers Technology Managed Care Outlook Desktop Resource Ad/Edit Index

Managed Healthcare Executive - November 2008

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