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.
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