The Texas Hospital Association has adopted new principles that address billing policies for serious medical mistakes, such as a wrong-site surgery or a patient death resulting from giving a transfusion of the wrong blood type.
Lacking a national framework for how hospitals should be reimbursed when a serious adverse event occurs, the Texas Hospital Association Board of Trustees approved a policy at a recent meeting which incorporates five principles to guide hospitals in developing their own internal policies regarding billing for care related to a serious adverse event.
Texas joins at least a dozen other state hospital associations and the American Hospital Association in adopting guidelines for voluntary discounting or waiving of payment for care associated with serious, adverse events.
Since the THA Board’s adoption of the policy in mid-May, THA has been encouraging individual hospitals to adopt policies based on the principles.
THA has also shared its principles and rationale with health plans, which are beginning to address reimbursement policies for these rare events in their contract negotiations. Blue Cross and Blue Shield of Texas already has indicated that it will base its reimbursement guidelines on THA’s principles.
Applicable to the care made necessary by the serious adverse event, THA’s principles state that the error or event must be preventable and within the control of the hospital. Another principle states that the error or event must be the result of a mistake made in the hospital, such as a hospital procedure not being followed. The error or event must result in significant harm, and be something that can be clearly and precisely defined in advance.
THA identified nine specific examples which may qualify for nonpayment under its new principles:
1. Surgery performed on a wrong body part.
2. Surgery performed on the wrong patient.
3. The wrong surgical procedure performed on a patient.
4. Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a facility.
5. An infant discharged to the wrong person.
6. Patient death or serious disability associated with a hemolytic reaction due to the administration of ABO-incompatible blood or blood products.
7. Death or serious disability, including kernicterus, associated with failure to identify and treat hyperbilirubinemia in neonates during the first 28 days of life.
8. Artificial insemination with the wrong donor sperm or donor egg.
9. Patient death or serious disability associated with a burn incurred from any source while being cared for in a facility.
THA also is working with the American Hospital Association to develop national standards to minimize administrative costs and create uniform expectations for all hospitals and payers.