Anthem won't cover wrong procedures or fixes
Thursday, April 03, 2008
MASON — When Ohio hospitals make preventable mistakes on patients, Anthem Blue Cross and Blue Shield will no longer pay for doing the wrong procedure or fixing the problem that results.
The policy, to take place by the end of this year, covers 11 "preventable adverse events," as defined by the Centers for Medicare and Medicaid Services (CMS) and the National Quality Forum.
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Before it goes into effect, Anthem will work with doctors and hospitals to use "appropriate processes, technologies and strategies to address 'never events' and, ultimately, to enhance the quality of care delivered to hospitalized patients," medical director Dr. Barry Malinowski, using the term for medical errors that are never excusable.
It also will help doctors and hospitals "analyze why and how these events occur, and to proactively find ways to improve patient safety and clinical care," he said. The list of mistakes will be changed or expanded as evidence warrants.
Anthem will not pay anything for three surgical medical errors: operating on the wrong body part, the wrong patient or doing the wrong surgery on the right patient.
For these eight mistakes, it will pay only the normal costs of error-free medical care:
• Leaving something in the body during surgery
• Pressure ulcers, commonly called bed sores.
• Giving blood of the wrong type
• Air embolisms, which block blood circulation
• Urinary tract infections associated with catheters
• Vascular infections associated with catheters
• Certain chest infections after coronary bypass surgery
• Hospital-acquired injuries such as fractures, dislocations, intracranial injuries, crushing injuries and burns
Anthem already includes patient-safety measures in its programs to reward providers for high quality, and is the first insurer to track and compare the collective health of all enrollees, based on 40 components in 20 clinical areas.
