Health Insurers To Refuse Payment, Billing For Care Related To Hospital Errors

Main Category: Health Insurance / Medical Insurance
Also Included In: Public Health
Article Date: 16 Jan 2008 - 6:00 PDT

email to a friend   printer friendly   view / write opinions   rate article

Several private health insurers, such as Aetna and WellPoint, have moved to end reimbursements to hospitals for treatment that results from serious medical errors, the Wall Street Journal reports. The insurers also will not allow their members to be billed for hospital errors.

Last year, CMS announced a rule under which Medicare after September no longer will reimburse hospitals for the treatment of bed sores, falls and six other preventable conditions that occur in the facilities. CMS next year plans to add to the list hospital-acquired infections, blood clots in legs and lungs, and pneumonia contracted from a ventilator.

In hospital contracts that require renewal, Aetna has begun to include a provision that ends reimbursements for 28 "never events" outlined by the National Quality Forum. In Virginia, WellPoint has begun to test a similar policy that ends reimbursements for four never events, and the company plans to expand the policy to Georgia, New England and New York in the near future. UnitedHealth Group and Cigna have considered policies similar to the CMS rule.

According to the Journal, although private health insurers are "looking first at banning reimbursements for only the gravest mistakes," such as surgeries on the wrong limbs and the administration of incompatible blood, "it is only a matter of time before the industry also stops paying for some of the more common and less clear-cut problems that Medicare is tackling, such as hospital-acquired catheter infections or blood poisoning." Health insurers maintain that the policies will help improve patient safety and reduce health care costs.

However, some hospitals and others have raised concerns that the "new strategy could drive up medical costs in other ways as hospitals absorb or pass on the expense of introducing the safety and screening procedures needed to help avoid mistakes," the Journal reports (Fuhrmans, Wall Street Journal, 1/15).

Reprinted with kind permission from http://www.kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.