Managed Healthcare Executive - November 2008 - (Page 24)

{ HOSPITALS AND PROVIDERS } renewed contract has agreed to adopt the insurer’s policy in tackling never events. “We are encouraged by the response to this new concept and believe as we, and others, continue to have dialogue about the intent of this language, more hospitals will include never events language in their contracts,” says Aetna Spokeswoman Karin Rush-Monroe. CIGNA is exploring internal guidelines regarding nonpayment of never events, not as a cost savings initiative, but as a way of improving patient safety, explains Doug Hadley, MD, CIGNA’s medical o cer. “Our policy is designed to be consistent with Medicare’s rules because we believe those rules provide hospitals exibility on avoidable hospital conditions and the rules surrounding other complications and [chronic illnesses],” Dr. Hadley says. CMS’s policy has the support of some hospital systems as well. Last November, Massachusetts hospitals announced that they would not charge for nine serious medical errors. Other state hospital trade groups adopting similar non-billing policies include Colorado, Minnesota, Tennessee, and Vermont. Despite the stricter mandates from Medicare and other health plans, medical mistakes are routine in many American hospitals. For instance, the California Department of Public Health in August ned 18 hospitals for state health code violations in which patients were victims of accidents ranging from surgical tools left inside bodies to procedures performed on the wrong body parts. In July, the Joint Commission, a nonpro t that accredits hospitals in the United States, updated its guidelines for preventing wrong-site surgeries. Beginning in 2009, doctors must conduct a preprocedure veri cation process, as well as mark the body area they plan to incise before surgery begins. Also, nurses are 24 NOVEMBER 2008 supposed to run through a checklist of steps in the operating room before the procedure begins—and call a halt when something falls below standards. Some observers say enacting such a checklist is sensible, but ies in the face of the hierarchical culture in some operating rooms where doctors typically aren’t inclined to perform by the numbers. Furthermore, some nurses feel uncomfortable taking a leading role in an operation. EXECUTIVE VIEW More hospitals are willing to include never events in their contract terms. Some are concerned that rules do not reﬂect reality. Insist that providers implement more quality protocols. However, nurses are taking the controls within the Michigan Health and Hospital Assn. (MHA), a Lansing-based healthcare group comprised of 146 community hospitals. In June, MHA launched an initiative that combines extensive patient safety data collection and analysis, as well as best patient care practices. Sam Watson, executive director of MHA’s Keystone Center for Patient Safety & Quality, says the hospital association isn’t developing extraordinary innovations, but carrying out logical, clear-cut measures to bolster safety success in members’ operating rooms. MHA doctors placing central lines are required to use the checklist. If they miss a step or fail to follow the checklist procedure properly, the nurse asks the doctor to stop the procedure and correct the error and/or restart the procedure. “Basically, we are changing that [hierarchical] culture in the operating room,” Watson says. MHA in 2006 launched the “Keystone: Hospital Acquired Infections” pro- gram, which Watson says was spurred by an MHA initiative launched in early 2004 to improve patient safety and healthcare quality by reducing errors in hospital intensive care units. Keystone, funded in part by Blue Cross Blue Shield of Michigan, saw a 66% drop in catheter-related bloodstream infections of ICU patients after just three months. Watson explains that implementing strict sanitary measures brought about some striking results. He says once fully implemented in 120 intensive care centers in 76 hospitals, the Keystone program saved 1,700 lives and $165 million in healthcare costs between 2004 and 2007. That includes savings associated with lower urinary-catheter infection rates and costly conditions. LEAPFROG LESSONS Aetna sees the value of curbing medical mistakes before they crop up. One direction the insurer is taking is its collaboration with the Leapfrog Group. Lori Metz manages the Leapfrog Hospital Rewards Program, which o ers incentives to hospitals that implement e ective patient care initiatives. Metz says they are working with experts to develop a second-generation hospital rewards program based on Leapfrog’s experience with the rst-generation plan, as well as lessons learned through other pay-for-performance projects. Metz says the second generation hospital rewards program will be based solely on data collected through its 2008 Leapfrog Hospital Survey. The group has designed the survey to reduce the burden of reporting for hospitals and to incorporate the latest research on measures with the greatest impact on saving costs and improving quality. Guy D’Andrea, president and founder of Discern Consulting LLC of Baltimore, is helping Leapfrog Group implement the program. He explains that the incentives of-

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Managed Healthcare Executive - November 2008

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