BCBS Illinois To End Reimbursements To Hospitals For Treatment Related To Serious Medical Errors

Main Category: Health Insurance / Medical Insurance
Article Date: 08 Aug 2008 - 7:00 PDT

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Blue Cross Blue Shield of Illinois recently announced plans to end reimbursements to hospitals for treatment that results from serious medical errors, the Chicago Tribune reports. BCBS Illinois spokesperson Jack Segal said that the health plan has not finalized a list of serious medical errors included under the policy. He said, "The majority of hospitals do not bill us for never events, but given the complexity of billing, billing systems and billing agencies, some never events may slip through," adding, "With this new policy in place, we can work to close the gaps, and also focus on improving quality."

Elena Butkus -- vice president of finance for the Illinois Hospital Association, which represents about 200 hospitals in the state -- said the group supports the policy. She said, "We are committed that patients and payers not pay for care related to a never event that was within the hospital's control and preventable." However, she raised concerns that the policy might include treatment for some conditions not "under the hospital's control to begin with," such as certain infections commonly acquired in hospitals that patients might have contracted before they arrived.

Industrywide Trend
According to the Tribune, BCBS Illinois announced the policy as part of an "industrywide shift toward more consumer-friendly practices," based on the "idea ... that forcing hospitals to absorb those costs will create an incentive to improve quality of care in a business where money typically rolls in regardless of patient outcomes" and where patients "often feel lost in a complex, impersonal system" (Japsen, Chicago Tribune, 8/7).

In August 2007, CMS announced that as of Oct. 1 Medicare no longer will reimburse hospitals for the treatment of certain "conditions that could reasonably have been prevented," and that the facilities "cannot bill the beneficiary for any charges associated with the hospital-acquired complication" (Kaiser Daily Health Policy Report, 8/1). CMS last month announced additions to a list of preventable conditions for which Medicare will no longer pay hospitals to treat (Graham, "Triage," Chicago Tribune, 8/7).

In addition, some private health insurers, such as Aetna, have begun to end reimbursements to hospitals for treatment that results from serious medical errors (Chicago Tribune, 8/7).

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