Darien, Ill. — While no doctor intends to harm a patient, even the most skilled and well-intentioned medical professionals can make mistakes -- mistakes that should never happen. Yet there are medical mistakes so serious, so outrageous, that they are called "Never Events." Insure.com, which owns and operates a consumer information service and companion insurance brokerage service that caters to the needs of self-directed insurance shoppers, examines these cases and their resultant claims in a new report.
The surgical sponge is one of the most common objects left in patients after surgery. A 2003 study by The New England Journal of Medicine found that roughly 4,000 sponges are accidentally left inside patients annually. In at least 88% of these cases, the medical staff had falsely recorded a correct sponge count after surgery. The study, focusing on 54 patients who filed claims for a Never Events, found that 69% of the foreign objects left behind after surgery were sponges and 31% were medical instruments. Thirty-seven of those patients required corrective surgery and one died.
The situation has become so dire that medical-equipment companies invented sponges with RFID (radio frequency identification) tags in them to closely track their whereabouts.
Health insurers and Medicare have issued payments to physicians for these mistakes for years, according to a report issued by Insure.com. Under the old system, patients and their insurers experienced the added insult of receiving a bill for corrective surgery resulting from medical mistakes. In August 2008, 23 states decided that hospitals can no longer bill patients and insurers for medical mistakes beginning in 2009. There are currently 12 states that already operate this way. The states that won’t allow hospitals to bill patients or their insurers for preventable errors are Delaware, , Indiana, Maine, Massachusetts, Minnesota, Oregon, New Hampshire, Pennsylvania, South Carolina, Vermont and Washington .
In October 2008, the Center for Medicare and Medicaid Services stopped reimbursing hospitals for the costs of fixing certain medical mistakes.
Now, major insurers such as CIGNA are announcing that they will tear up bills for Never Events.
"We divided up the Never Events and categorized them under unavoidable hospital conditions versus avoidable hospital conditions. Medicare [guidelines] helped us select what to focus on first: What is the most prevalent and what is easiest to correct," Mark Slitt, spokesperson for CIGNA Healthcare, says in the report.
In January 2008, Aetna announced that it would stop paying for the 28 Never Events named by the National Quality Forum. WellPoint has initiated a pilot program in Virginia that will not pay for four types of medical errors, including surgery performed on the wrong body part, surgery performed on the wrong patient and the wrong surgery performed on a patient. When it comes to corrective surgeries that involve the removal of an object left inside the patient, or giving a patient the wrong blood type, WellPoint says that the hospital must now foot the bill. Along with other major insurers, UnitedHealthcare and all 39 Blue Cross and Blue Shield plans are considering putting Never Event bills in the "do not pay" file, notes the report.
For the full article, see "Insurers start to tear up bills for medical mistakes" at http://www.insure.com/articles/healthinsurance/never-events.html.
Exclusive content nly available on InsuranceNetworking.com
Register or login for access to this item and much more
All Digital Insurance content is archived after seven days.
Community members receive:
- All recent and archived articles
- Conference offers and updates
- A full menu of enewsletter options
- Web seminars, white papers, ebooks
Already have an account? Log In
Don't have an account? Register for Free Unlimited Access