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AIS's Health Business Daily
Featured Story July 9, 2008 Hospitals Should Employ a Four-Step Policy After a 'Never Event' OccursReprinted from REPORT ON MEDICARE COMPLIANCE, the nation's leading source of news and strategic information on false claims, overpayments, compliance programs, billing errors and other Medicare compliance issues. By Eve Collins, Associate Editor (ecollins@aispub.com) Hospitals should apologize to the family of a patient who suffers a "never event," experts say. Apologizing is both the right thing to do and the best thing from a risk-management perspective. Apologies are one of the four steps hospitals should take if a never event becomes an actual event, according to two major insurers and an organization representing large employers. They described the steps during a recent AIS audioconference. Never events — which CMS defines as "serious and costly errors in the provision of health care services that should never happen" — have become a hot topic. Hospital associations in several states have vowed not to charge patients or their health plans for adverse events. Two Medicaid agencies (New York and Pennsylvania) have said that they will not pay hospitals for the errors. And Maine recently passed a law prohibiting hospitals from charging for adverse events. So health plans and other groups are creating policies on the errors and adding them to their contracts with providers. The errors are based on a list of 28 events compiled by the National Quality Forum (NQF) in 2002 and revised in 2006. CMS also is linking payments to never events. Starting Oct. 1, Medicare won't pay for eight conditions if they were acquired in the hospital and not present on admission; CMS announced plans to add nine more hospital-acquired conditions (HACs) to the payment restrictions in the inpatient prospective payment system rule proposed April 14. Speakers at the May 13 audioconference, "Never-Event Payment Policies: How Major Plans Are Getting Tough on Preventable Hospital Errors," all agreed that hospitals should do four things if an adverse event occurs:
Leah Binder, CEO of the Leapfrog Group, said more than half of the 1,285 hospitals that participated in the organization's 2007 annual survey have already adopted this policy. It's contrary to physicians' beliefs, but data show that apologizing deters malpractice suits, she said. Apologizing is human decency, she added, and is "critical to the proper and appropriate approach to these events that should never happen." Jay Schukman, M.D., medical director of Anthem Blue Cross Blue Shield of Virginia, said policies on adverse events face some challenges. First, only some state hospital associations are supporting them, and reporting rules vary among the states. Also, some insurance companies are following CMS's conditions, while others are implementing all 28 NQF events. And some insurers are focusing only on acute-care hospitals and leaving out freestanding surgery centers and physicians, he said. Furthermore, there aren't enough codes for wrong surgery events, said Schukman, adding that it has not been determined how to adjudicate claims when the present-on-admission issue is disputed. Charles Cutler, M.D., Aetna Inc.'s chief medical director, pointed out that CMS's list of conditions is "a little more complicated" than NQF's events because it requires some judgment, including whether the condition was present on admission. Many of NQF's events are more straightforward, he said. As for the CMS payment restrictions for HACs, Cutler said that CMS has many advantages over health plans because of its size and authority. "[It also has] the ability to mobilize the [quality improvement organizations] to do the kinds of detailed analysis at the hospital and medical-record level, which health plans don't. So there are ways in which CMS could implement a program which requires much more robust clinical information that would be very challenging for a health plan to implement," he said. "Once we learn as much as we can from the NQF never events, we're developing the capability to address other patient safety challenges as well, but we saved that [for] a little bit in the future," Cutler continued. To purchase a recording of AIS's May 13 audioconference, Never-Event Payment Policies: How Major Plans Are Getting Tough on Preventable Hospital Errors, please call (800) 521-4323 or click here. |
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