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Who pays for serious preventable errors in medical care?

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An article on looks at who actually pays for follow-up care resulting from preventable medical errors, finding that responsibility for payment lands on the insurer and the insured.

Beginning in October, Medicare will cease paying hospitals for at least eight complications arising from preventable medical errors, and a number of other conditions are expected to be added this week. Beneficiaries may not be billed either.

A new report from The Commonwealth Fund finds that although the United States spends twice per capita what other major industrialized nations do on health care, it lags behind in quality. According to Consumers Union, hospital-related errors and infections kill nearly 200,000 Americans and injure another 2.6 million every year, adding billions to the cost of health care.

Who is doing what? – a look at what states, hospital assocations and private insurers are doing

The American Hospital Association and many state hospital associations have adopted guidelines for voluntary discounting or waiving of payment for care associated with serious, adverse events – including Hospital Associations in Vermont, Minnesota, Massachussets, Tennessee, Colorado, Texas and South Carolina. And many states advise hospitals not to charge for serious, preventable errors – including California, Delaware, Georgia, Indiana, Maine, Massachussets, Minnesota, NY, Oregon, Pennyslvania, South Carolina, Vermont and Washington.

New Jersey will end payment for these serious, preventable “never events” in its Medicaid program, and the South Carolina Department of Health and Human Services, which administers the Medicaid program, is looking at doing that there.

Other States are moving towards greater transparency in reporting medical errors including New Jersey, Colorado and Rhode Island.

Not paying for care associated with preventable events is a movement that is gaining ground with private insurers as well. Some insurers have also begun to include provisions in contracts that they will not pay for (or let patients be billed for) care related to 28 “never events” compiled by the National Quality Forum. These include Aetna, Blue Cross Blue Shield and Wellpoint. As reported on today, Preferred Health Systems, Kansas’ largest health insurer, announced last week that it will stop reimbursing hospitals for costs related to avoidable medical complications from Oct. 1. Blue Cross and Blue Shield of Kansas has said it will formalize its long-standing policy of refusing payment for avoidable complications effective Jan. 1, 2009.

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