Surgery News - February 2008 - (Page 2)

NEWS SURGERY NEWS • F E B R U A RY 2 0 0 8 Aetna to Refuse Payment for Preventable Errors B Y M A RY E L L E N S C H N E I D E R Else vier Global Medical Ne ws I n a move that could have significant implications for physicians and hospitals, the insurer Aetna has said it will not pay its network hospitals for care necessitated by certain preventable errors. The announcement follows a policy shift by the Centers for Medicare & Medicaid Services, which has finalized plans to stop paying for eight preventable events as of October 2008. Aetna Inc. has put language in its hospital contracts that calls for waiving all costs related to several serious reportable events. The language comes from the Leapfrog Group’s “never events” policy, which lists 28 events considered so harmful that they should never occur. The list, compiled by the National Quality Forum (NQF), comprises events ranging from surgery on the wrong body part to stage III or IV pressure ulcers acquired after admission to a health care facility. The policy instructs hospitals to report errors within 10 days to the Joint Commission, state reporting programs, or patient safety organizations, and to take action to prevent future events. Aetna is the first health plan to endorse the Leapfrog policy. Adopting the Leapfrog policy is not about saving money, said Dr. Charles Cutler, Aetna’s national medical director. In fact, many of the never events add no cost. Instead, the goal is “to get hospitals to focus on having the systems in place to prevent these events.” But the Aetna announcement has encountered some skepticism from the physician community. First, the NQF list of 28 never events is broader than the 8 events selected under the Medicare policy, said Cynthia Brown, director of the division of advocacy and health policy at the American College of Surgeons (ACS). Many of those events were left off Medicare’s list because they are difficult to measure, she said. Another problem with Aetna’s approach is that it’s hard to affix blame to a hospital or a particular physician. Ms. Brown said. When used properly, the NQF never events list protects patients and directs a patient environment enriched with safety and quality, said Dr. Frank Opelka, chair of the ACS Committee on Patient Safety and Quality Improvement, and an ACS Fellow. But he cautioned that if payers drift from the intentions of the NQF never events, the specifications could be lost and over-reporting could create needed to establish specific requirements for equipment and staff qualifications. The report was requested by the Senate Finance Committee, whose leaders—Sen. Chuck Grassley (R-Iowa) and Sen. Max Baucus (D-Mont.)—have sought restrictions on physician-owned specialty hospitals. Physician Hospitals of America, which represents 108 physician-owned facilities, believes all hospitals should meet Medicare conditions of participation, but not every hospital should have an ED, said Molly Sandvig, the organization’s executive director, in an interview. “No hospital should use 911 as a substitute for providing proper care to patients,” said Ms. Sandvig. That practice is very limited, she said, alleging that the IG had misrepresented facilities’ policies and practices. Both the American Hospital Association and the Federation of American Hospitals unintended consequences. For example, because of hospital overcrowding and limited resources in a rural environment, a frail patient may be admitted despite the lack of health care resources. If the patient has a pressure ulcer that progresses from a stage II on admission to a stage III, this should not be considered an NQF never event, he said. In addition, there is a question as to whether hospitals would continue to report these serious preventable errors if they aren’t being paid for the care, said Dr. Opelka, who is also vice chancellor for clinical affairs at Louisiana State University Health Sciences Center, New Orleans. The policy is likely to affect all of Aetna’s network hospitals over the next 3 years as the company renegotiates its contracts, Dr. Cutler said. ■ said the report shows that physician-owned facilities are a threat to patient safety. “The report illustrates yet another reason why Congress needs to take action in the best interests of patients and ban physician self-referral to new limited-service hospitals they own and operate,” AHA Executive Vice President Rick Pollack said in a statement. “Surgeons are paid for providing patient care,” said Dr. James W. Jones, who commented on the report. “To add sources of supplementary revenue is to invite a conflict of interest.” Physicians aren’t trained in hospital management or safe cost cutting, so the findings of this investigation aren’t surprising, said Dr. Jones, an ACS Fellow and visiting professor at the Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston. “All of us in medicine should be embarrassed by these data,” he added. ■ Staffing, Policies Scrutinized Specialty Hospitals • from page 1 requirements: having a registered nurse on duty at all times, and a physician on call at all times. But seven hospitals had no R.N. on duty, one had no physician on call or on duty on at least 1 of the 8 days reviewed, and two-thirds of the hospitals told staff to call 911 in case of emergency. While transferring a patient with an emergent problem to another hospital’s ED is acceptable, it might be a violation of Medicare conditions for participation if a hospital uses 911 to obtain medical assistance to stabilize a patient, according to the IG. Thirty-seven of the 109 hospitals (34%) engaged in that practice, the IG reported. Almost 25% of the hospitals did not address in written policies the “appraisal of emergencies, initial treatment of emergencies, or referral and transfer of patients,” according to the report. The IG urged the CMS to enforce Medicare staffing requirements. The CMS issued a written response saying it agreed with the IG’s recommendations and that it would examine current compliance through its routine hospital surveys. As many as 42% of the 109 hospitals would not have been subject to CMS oversight, however, the IG said. Those facilities were instead accredited by the Joint Commission or the American Osteopathic Association. The CMS said it would require hospitals to have written policies and procedures on managing emergencies, but would also consider whether regulatory changes are SURGERY NEWS SURGERY NEWS Editor in Chief, SURGERY NEWS Lazar J. Greenfield, M.D., FACS ACS Director of Communications Linn Meyer EDITORIAL ADVISORY BOARD Anesthesiology: Robert Morell, M.D., Clinical Associate Professor of Anesthesia, Fort Walton Beach Medical Center Bariatric: Myriam J. Curet, M.D., FACS, Professor of Surgery, Stanford University Cardiothoracic: Mark S. Allen, M.D., FACS, Professor of Surgery, Mayo Clinic Cardiothoracic: Fred A. Crawford, Jr., M.D., FACS, Chairman, Department of Surgery, Medical University of South Carolina Colorectal: Robert Madoff, M.D., FACS, Professor of Surgery, University of Minnesota Endocrine Surgery: Robert Udelsman M.D., FACS, Chairman, Department of Surgery, Yale University Ethics: James W. Jones, M.D., Ph.D., FACS, Visiting Professor of Medicine and Medical Ethics, Baylor University Information Technology: Patricia L. Turner, M.D., FACS, Assistant Professor of Surgery, University of Maryland Minimally Invasive and Gastrointestinal: Gerald M. Fried, M.D., FACS, Professor of Surgery, McGill University Neurological: Hunt Batjer, M.D., FACS, Michael J. Marchese Professor, Northwestern University Obstetrics and Gynecology: William J. Hoskins, M.D., FACS, Executive Director of Surgical Activities, Memorial Sloan-Kettering Cancer Center Ophthalmology: Natalie C. Kerr, M.D., FACS, Chief, Pediatric Ophthalmology Service, University of Tennessee Orthopedic: Mark R. Belsky, M.D., FACS, Chief of Orthopedic Surgery, Newton-Wellesley Hospital Otolaryngology: Mark Weissler, M.D., FACS, J.P. Riddle Distinguished Professor, University of North Carolina Pediatric Surgery: Thomas F. Tracy, Jr., M.D., FACS, Pediatric Surgeon-in-Chief, Hasbro Children's Hospital Plastic Surgery: Linda Phillips, M.D., FACS, Truman G. Blocker Jr., M.D. Distinguished Professor, University of Texas Resident/Associate Society: Ted A. James, M.D., Assistant Professor of Surgery, University of Vermont Surgical Oncology: James P. Neifeld, M.D., FACS, Chairman, Department of Surgery, Virginia Commonwealth University Transplantation: Jeffrey Punch, M.D., FACS, Associate Professor of Surgery, University of Michigan Trauma (Burns and Mass Casualties): Steven E. Wolf, M.D., FACS, Professor of Surgery, University of Texas Trauma and Critical Care: Grace S. Rozycki, M.D., FACS, Professor of Surgery, Emory University Urology: Badrinath R. Konety, M.D., FACS, Vice Chair, Dept. of Urology, University of California at San Francisco Vascular: Linda Harris, M.D., FACS, Associate Professor of Surgery, Millard Fillmore Hospital SURGERY NEWS is the official newspaper of the American College of Surgeons and provides the practicing surgeon with timely and relevant news and commentary about clinical developments and about the impact of health care policy on the profession and on surgical practice today. Content for SURGERY NEWS is provided by International Medical News Group and Elsevier Global Medical News. Content for the NEWS FROM THE COLLEGE is provided by the American College of Surgeons. The ideas and opinions expressed in SURGERY NEWS do not necessarily reflect those of the College or the Publisher. The American College of Surgeons and Elsevier Society News Group, a division of Elsevier Inc., will not assume responsibility for damages, loss, or claims of any kind arising from or related to the information contained in this publication, including any claims related to the products, drugs, or services mentioned herein. POSTMASTER: Send changes of address (with old mailing label)

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Surgery News - February 2008 Contents IOM Committee Looks Into Safety Of Work Schedules Expertise Can Extend Liver Resectability Report Faults Specialty Hospitals' EDs Meeting Expectations Silver Lining HOD on Health Longer Liver Life?

Surgery News - February 2008

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