WellPoint To Stop Paying For Treatment Of Preventable Hospital Errors, Injuries

Main Category: Health Insurance / Medical Insurance
Also Included In: Public Health
Article Date: 07 Apr 2008 - 7:00 PDT

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Officials from WellPoint and its subsidiary Anthem BlueCross BlueShield on Wednesday announced that, beginning Oct. 1, they will no longer reimburse hospitals for treatment of three preventable errors and eight avoidable injuries and infections that occur in the facilities, the St. Louis Post-Dispatch reports. The companies provide health coverage for about 35 million U.S. residents. The change comes after Medicare adopted a similar policy last year (Feldstein, St. Louis Post-Dispatch, 4/3).

The 11 errors under the new rule were defined as preventable by CMS and the National Quality Forum. The policy prohibits payments to hospitals for surgeries on the wrong body part, incorrect surgeries or surgeries on the wrong patient. The insurer also will not reimburse hospitals for avoidable errors, such as bed sores, surgical instruments left in the body after surgery and urinary tract infections linked to catheter use. The insurer will use several different methods to determine if errors were made, including comparing patients' diagnoses and conditions when they were admitted with the treatment they received in the hospital (Lee, Indianapolis Star, 4/3). Under the policy, patients also will not be charged for treatment related to preventable errors (St. Louis Post-Dispatch, 4/3).

American Public Media's "Marketplace Morning Report" on Thursday reported on the policy. The segment includes comments from Sam Nussbaum, chief medical officer for WellPoint, and Atul Gawande, a surgeon at Brigham and Women's Hospital in Boston (Milen-Tyte, "Marketplace Morning Report," American Public Media, 4/3). Audio and a transcript of the segment are available online.

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