No Fee for Errors
State governments, private payors, Medicare, and hospitals have reached the same conclusion: Hospitals should not charge for preventable medical errors.
One of the latest entities to join this trend is Washington state. Early this year, healthcare associations there passed a resolution saying Washington healthcare providers no longer will charge for preventable hospital errors. The resolution applies to 28 “never events” published by the National Quality Forum (NQF). These are medical errors that clearly are identifiable, preventable, serious in their consequences for patients, and indicative of a real problem in the safety and credibility of a healthcare facility. (For a complete list of events, visit NQF’s Web site (www.qualityforum.org/pdf/news/prSeriousReportableEvents10-15-06.pdf).
PCPs Go International
A new report by the Government Accountability Office (GAO) reveals the makeup of primary care physicians is changing. Fewer Americans are pursuing careers in primary care, but more international physicians are choosing that field. As of 2006, there were 22,146 American doctors in U.S. primary care residencies—down from 23,801 in 1995, or 7.5%. The number of international medical graduates training in primary care, however, grew from 13,025 to 15,565, or 19.5%, in the same period. For a copy of the GAO report, visit https://help.senate.gov/Hearings/2008_02_12/Steinwald.pdf
Quality ROADMAP ONLINE
The Hospital Quality Alliance (comprising the American Hospital Association, the American Association of Medical Colleges, and the Federation of American Hospitals) has published the “2008 Quality Roadmap for Hospitals,” a concise guide to new quality data collection and public reporting requirements. Download it at www.aha.org/aha_app/advisory/most-recent.jsp.
Hospital Spending Continues to Rise
In a 2007 report, the CMS predicted hospital spending will double in the next 10 years, reaching more than $1.3 trillion by 2017 and making up approximately 30% of all healthcare spending and representing the largest portion, by far, of any provider group.—JJ
Hospitals in Massachusetts, Minnesota, Pennsylvania, and Vermont have adopted similar policies. Private insurers Aetna, Wellpoint, and Blue Cross Blue Shield each are taking steps toward refusing payment for treatment resulting from serious medical errors in hospitals.
Amid these decisions, the American Hospital Association (AHA) released a quality advisory Feb. 12, recommending hospitals implement a no-charge policy for serious adverse errors.
“There’s certainly been a lot of conversation about aligning payment around outcomes,” says Nancy E. Foster, the AHA’s vice president for quality and patient safety policy. “Most of those conversations have focused on reward for doing the right thing, but there were certainly parts of those conversations based on the notion of who’s responsible and who pays when something that was preventable did happen.”
Even the federal government has gotten involved. Beginning in October, the Centers for Medicare and Medicaid Services (CMS) plans to no longer reimburse for specific preventable conditions.
CMS “Stop Payments”
If Congress approves Medicare’s plan, the CMS will not pay any extra-care costs for eight conditions unless they were present upon admission—and it prohibits hospitals from charging patients for such conditions. The conditions include three “never events”:
- Objects left in the body during surgery (“never event”);
- Air embolism (“never event”);
- Blood incompatibility (“never event”);
- Falls;
- Catheter-associated urinary tract infections;
- Pressure ulcers (decubitus ulcers);
- Vascular catheter-associated infection; and
- Surgical site infection after coronary artery bypass graft surgery (mediastinitis).
