No pay for "never event" errors becoming standard

The emerging ethical and patient safety imperative is that hospitals should not be reimbursed for medical errors that should never happen.

By Kevin B. O'Reilly, AMNews staff. Jan. 7, 2008.

The movement to align patient safety and payment seems to be picking up a full head of steam. Hospitals and payers are coalescing around the idea that no one should get paid for so-called never events -- serious reportable events, such as wrong-site surgery, that kill or maim patients.

Perhaps most significantly, the BlueCross BlueShield Assn. announced in November 2007 that its plans will work toward ending payment for never events. The change will be phased in over several years as the Blues alters its coding and claims processes. A spokesman said adoption will vary among the 39 Blues plans, which insure more than 100 million people, because the change requires renegotiating contracts and securing agreements from local physicians and hospitals.

Many hospitals also have stepped forward on the issue. In September 2007, Minnesota hospitals and insurers agreed that patients and health plans should not be billed for care associated with a list of 28 never events endorsed by the National Quality Forum, a voluntary consensus standard-setting organization. Last month, 61 Massachusetts hospitals announced they will stop charging for nine NQF-defined never events, such as sending a baby home with the wrong family or performing a procedure on the wrong patient. Nationally, nearly 1,300 hospitals have pledged to waive all costs directly associated with never events.

The shift on never events comes on the heels of a new Centers for Medicare & Medicaid Services rule, issued in August 2007 and set to take effect in October 2008, that denies payment for eight hospital-acquired conditions. Five of the eight -- pressure ulcers, air embolism, blood incompatibility, object left in patient after surgery, and patient falls -- also are NQF-endorsed never events. It is widely expected that even more private payers will follow Medicare's lead in this area once the rule has been successfully implemented.