Hospitals in 23 states say they will no longer bill patients for very serious medical mistakes such as operating on the wrong body part or wrong person, or giving a patient the wrong blood. The list of such medical errors has doubled since February, in part over an MSNBC.com analysis that revealed that hospital associations in 11 states urged their members to waive payment for errors called “never events,” so named because they should never happen at all.
“It really does go to the heart of our patients’ confidence,” said Craig Becker, president of the Tennessee Hospital Association, which adopted a plan in June. “When you look at these adverse events, these are pretty gross errors.” Tennessee is among those states that approved non-payment policies for specific mistakes. Three more states are expected to follow suit by this fall and hospitals in another eight states have agreed to general guidelines that advise eliminating bills on a case-by-case basis for serious and preventable errors.
It remains unclear just how many private patients and insurers are being billed for medical mistakes; however, a July study conducted by the federal Agency for Healthcare Research and Quality estimated that preventable errors occurring during or after surgery may cost employers nearly $1.5 billion annually. Effective October 1, Medicare will no longer reimburse hospitals for the extra costs of treating certain injuries, infections, and complications occurring post-admission. Medicare has also added to its error list: Surgical site infections following elective orthopedic and bariatric surgeries, severe complications from poorly controlled blood sugar, and deep vein thrombosis—pulmonary embolism—following total knee and hip replacement surgeries. The agency is urging state Medicaid directors to implement the non-payment policies which are in place in Massachusetts, New York, and Pennsylvania and many of the nation’s largest insurers, including Cigna, Aetna, and Blue Cross Blue Shield, will no longer pay fo
r serious, preventable mistakes.
Now, states and hospitals must decide how to address these errors; policies differ from state-to-state and within hospital networks. Minnesota was the first to announce its hospitals would no longer charge patients or insurers for avoidable errors last September and other states soon followed. Now, five states agreed to waive fees for 28 “never events” identified by the National Quality Forum (NQF), a patient safety and advocacy agency. Other states will waive fees for eight-10 mistakes or have created lists that include errors such as sudden limb amputation to radiating the wrong body area. Utah lists 31 potential errors, including the unanticipated death of a full-term newborn and death or serious disability caused by a health care-acquired infection.
“Just because something defacto occurred on that list, that doesn’t mean that it’s defacto the fault of the provider,” said Karen Nelson, senior vice president for clinical affairs at the Massachusetts Hospital Association. Some conditions on NQF and Medicare lists may not be preventable or under the hospital’s control, noted Dr. Dan Stultz, president of the Texas Hospital Association, which announced a new policy last month recommending not billing for nine preventable errors. “ABO blood compatibility? I don’t have a problem with that. But if a titanium medical device fails because of a manufacturing defect, the hospital shouldn’t be held responsible, he said.
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