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Preferred Health Systems, Kansas' largest wellness insurer, proclaimed last week that it will stop reimbursing hospitals for costs related to avoidable medical complications, the Wichita Eagle reports. Beginning Oct. 1, treatment for "never events" -- including objects left in patients during surgery, use of the wrong blood type during a transfusion and certain infections -- testament no longer be covered by the insurer. On the same date, Medicare also will stop paid hospitals the higher rates for the increased monetary value of tending that results from such mistakes.
"The whole premise behind all this is to put hospitals on notice that these conditions and events need to stop to really solidify patient safety and (to) encourage hospitals to approve quality day in and day out, one affected role at a time," Preferred Health Chief Operating Officer Brad Clothier said. He added, "It really has to do with the focus we have on patient refuge."
Blue Cross and Blue Shield of Kansas has said it will formalise its longstanding policy of refusing payment for avertible complications efficient Jan. 1, 2009. BCBS spokesperson Mary Beth Chambers said, "We really feel that Kansas hospitals and Kansas providers are doing the best they can for patient role safety. We feel very strongly that we do not require to pay for these so-called ne'er events ... and we don't believe providers in our network expect us to pay for those events."
Hewitt Goodpasture, vice president for clinical quality and patient safety at Via Christi Wichita Health Network, said, "It's true that in the past times, hospitals got the benefit of the doubt -- to the extent hospitals get nonrecreational for these -- and were paid as though none of them were preventable. Now they're paying for them as though all of them were preventable, that's [not] true." He added, "I think there's some validity to doing it -- I'm not opposed to doing it, merely I'm opposed to vocation these things 'never events.' It may lead to doctors saying they're not going to mesh on this patient, it's too risky. It canful have unintended consequences on patients if it gets real punitory" (Atwater, Wichita Eagle, 7/28).
Reprinted with kind permission from hTTP://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, lookup the archives, or sign up for email delivery at hypertext transfer protocol://www.kaisernetwork.
