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Health Insurers To Refuse Payment For Hospital Errors

Armen Hareyan's picture

Severalprivate health insurers, such as Aetna and WellPoint, have moved to end reimbursements to hospitalsfor treatment that results from serious medical errors, the Wall Street Journal reports. The insurers also will notallow their members to be billed for hospital errors.

Last year, CMS announced a rule under which Medicare afterSeptember no longer will reimburse hospitals for the treatment of bed sores,falls and six other preventable conditions that occur in the facilities. CMSnext year plans to add to the list hospital-acquired infections, blood clots inlegs and lungs, and pneumonia contracted from a ventilator.

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In hospital contracts that require renewal, Aetnahas begun to include a provision that ends reimbursements for 28 "neverevents" outlined by the National QualityForum. In Virginia, WellPoint has begun to test a similar policythat ends reimbursements for four never events, and the company plans to expandthe policy to Georgia, NewEngland and New Yorkin the near future. UnitedHealthGroup and Cigna haveconsidered policies similar to the CMS rule.

According to the Journal, although private health insurers are"looking first at banning reimbursements for only the gravestmistakes," such as surgeries on the wrong limbs and the administration ofincompatible blood, "it is only a matter of time before the industry alsostops paying for some of the more common and less clear-cut problems thatMedicare is tackling, such as hospital-acquired catheter infections or bloodpoisoning." Health insurers maintain that the policies will help improvepatient safety and reduce health care costs.

However, some hospitals and others have raised concerns that the "newstrategy could drive up medical costs in other ways as hospitals absorb or passon the expense of introducing the safety and screening procedures needed tohelp avoid mistakes," the Journal reports (Fuhrmans, WallStreet Journal, 1/15).

Reprintedwith permission from kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, and sign upfor email delivery at kaisernetwork.org/email . The Kaiser Daily Health PolicyReport is published for kaisernetwork.org, a free service of The Henry J.Kaiser Family Foundation.