Starting this year, a few health insurers in the state say they’ll stop paying hospitals for conditions caused by medical mishaps.
Last year, Medicare implemented similar rules.
Proponents say that the trend will likely boost patient safety and lower healthcare costs.
NHPR’s Dianne Finch reports.
Nationwide, according to the US Centers for Disease Control, hospital errors overall cost as much as $27 billion a year - and as many as 100,000 lives.
So Aetna Inc. decided that beginning this year, it will no longer pay for nearly 30 different medical mishaps - called “never events”.
CUTLER: “They include things like operating on the wrong limb, doing the wrong operation on the wrong patient, having the failure of electrical equipment that causes serious injuries.”
Charles Cutler is a physician and medical director at Aetna.
He said that Aetna’s customers had been urging the company to reduce costs related to medical mishaps.
So the company adopted measures recommended by a national patient safety group made up of large employers and health policy experts.
And those measures will be written into new contracts with Aetna’s member hospitals.
CUTLER: “..which is that hospitals do a root cause analysis of what contributed to these never events occurring. Secondly that they report these events to the appropriate agency. They must apologize to the patients and or their families. And the last is not charge for complications of any of these events.”
One of Aetna’s clients is Hannafords – a grocery chain based in Maine.
Hannaford’s pays for about 70% of the healthcare costs for its 9,000 employees and their families – but the staff contribute the rest.
So everyone has a stake when it comes to medical costs.
Peter Hayes runs the company’s human resources division.
He applauds Aetna’s move – adding that his employees are becoming savvier about what they pay for in healthcare.
HAYES: “It’s much like any other consumer good…if anything else in market place if you take something in for repair you buy a product you expect that that product is defect proof and if it’s not then there is a process by which we can take that product back and get it fixed and there shouldn’t be an additional charge to the customers.”
Lucian Leape is a surgeon and a professor of health policy at Harvard School of Public Health.
Leap authored a landmark report for the Institutes of Medicine in 1994 that exposed the level of medical errors nationwide.
The report stunned the medical community and spurred national debate on patient safety issues.
Leape said that people at hospitals are not trying to make mistakes, but those mistakes can be lucrative.
LEAPE: “If you have an operation and then there’s a complication that the hospital and the surgeon will be paid more than if you didn’t have the complication. You’ll stay in the hosp a few more days sometimes a few more weeks and the hospital gets paid for that and the surgeon may have to do another operation or two and he or she gets paid for that. Ah that’s the way we’ve always done it and if was something that’s totally preventable – then we’re paying for unsafe care.”
Leape says that not reimbursing a hospital for those mistakes will likely reduce them.
But he added that ‘never events’ are relatively rare compared to infections picked up at hospitals.
And he predicts that insurers will likely add preventable infections to the no-pay list down the road.
LEAPE: “There are now a number of hospitals that have succeeded in completely eliminating infections associated with intravenous lines called central lines and since it is possible then I think its quite reasonable for payers or anyone else to say then why doesn’t everybody do that and the best way for that to happen is to say we’re not going to pay for them.”
But Leape also believes that doctors should be rewarded when things go well.
For example, he says that 90% of asthma patients could, if trained, manage their own illness at home.
But, he said, providers make more when asthma patients visit doctors or become hospitalized.
So he advocates bonuses or other incentives for providers when their patients’ health improve or when they learn to manage their diseases properly.
Aetna and others are already conducting pilot projects with hospitals that include those financial rewards.
Anthem Blue Cross and Cigna say that they’ll be testing out payment rules similar to Aetna’s by fall.
For NHPR News, I’m Dianne Finch
