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Health plans continue focus on non-payment for preventable medical errors

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Commencing on Oct. 1, Blue Cross and Blue Shield of Kansas City will stop paying hospitals to treat serious and often avoidable medical errors, otherwise known as “never events”, reports AHIP Hi-Wire. The halt in payments is designed as an incentive to hospitals to be meticulous about following safety guidelines — from frequent hand-washing to taking careful inventory of surgical objects.

Blue Cross is following the lead of Medicare, which announced last summer that on Oct. 1 it would stop paying hospitals for treating complications caused by the same list of avoidable conditions. The list includes:

  • Objects left inside a patient during surgery.
  • Use of the wrong blood type during transfusions.
  • Urinary tract infections associated with a catheter.
  • Bedsores.
  • Air embolism (a sudden artery blockage caused by air bubbles introduced during surgery).
  • Hospital-related injuries such as fractures, dislocations, head injuries and burns.
  • Severe chest infections after surgery.
  • Blood infections from a catheter.

The payment cuts for hospital complications are among the latest actions in a decade-old movement to save patient lives by preventing avoidable medical mistakes. A 1999 Institute of Medicine report projected that medical errors, particularly those at hospitals, could be causing 98,000 deaths per year. The Centers for Disease Control and Prevention had estimated that as many as 2 million patients a year pick up infections at hospitals.

The BlueCross BlueShield Association, which represents Kansas City Blue Cross and several dozen other Blues, announced in November that its member plans would work toward ending hospital payment for these kinds of mistakes.

Other insurers such as Aetna and Wellpoint now include provisions in some contracts that they will not pay for care related to 28 “never events” identified by the National Quality Forum. UnitedHealth Group and Cigna are also considering moves.

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