Turning the Tide? Insurers say "No Pay" to Preventable Medical Errors.
In what could be the turning point for the hospitals getting dramatically more diligent on preventing medical errors, Aetna and WellPoint have taken a bold, and needed, stance: no more paying for preventable medical errors.
According to an article in The Wall Street Journal:
"The companies are following the lead of the federal Medicare program, which announced last summer that starting this October, it will no longer pay the extra cost of treating bed sores, falls and six other preventable injuries and infections that occur while a patient is in a hospital. The following year, it will add to the list hospital-acquired blood infections, blood clots in legs and lungs, and pneumonia contracted from a ventilator.
Private insurers are looking first at banning reimbursements for only the gravest mistakes. But health-insurance executives say it is only a matter of time before the industry also stops paying for some of the more common and less clear-cut problems that Medicare is tackling, such as hospital-acquired catheter infections or blood poisoning. "I'd rather have the cudgel in place first than push the list too far," says Aetna President Mark Bertolini.
Some hospitals and others are concerned that the new strategy could drive up medical costs in other ways as hospitals absorb or pass on the expense of introducing the safety and screening procedures needed to help avoid mistakes.
Ultimately, insurers say, the efforts will trigger safety improvements and savings for patients."
But the policy is not to save the insurers money, it's to save lives. According to, Thomas Granatir, director of policy and research at Humana, Inc.--which is working on a policy similar to Medicare's, "It's not a matter of not paying for them. It's about getting them not to happen in the first place."
As it stands now, insurers are taking a zero-tolerance stance by refusing to pay for care triggered by "never-events," those events that should just "never happen," including:
- Object left in patient after surgery
- Letting patient wander or disappear
- Administering wrong blood type
- Artificially inseminating wrong donor sperm or egg
- Allowing patient to fall
- Operating on wrong limb
- Performing wrong procedure
- Using contaminated drugs or devices
- Discharging infant to wrong person
- Mother's death or serious disability in low-risk delivery
- Hospital-acquired bedsores
- Patient abduction or sexual assault
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