Hospitals urged to waive bill, apologize for `never events'

November 16, 2006|By Bruce Japsen | Bruce Japsen,Chicago Tribune

CHICAGO -- Tired of paying for botched medical procedures and low-quality medical care, some of the nation's largest businesses called on U.S. hospitals yesterday to agree to apologize and waive costs related to so-called "never events" - medical errors these employers say should never happen.

Both the Leapfrog Group, a national coalition of large health care purchasers such as Boeing Co., General Motors Corp., General Electric Co., Lockheed Martin Corp. and Marriott International Inc., and the Midwest Business Group on Health, a Chicago business coalition representing more than 80 local employers, said hospitals should commit to new policy on 28 health care never events as a way to make providers of medical care more accountable.

Many of the errors, such as a surgery performed on the wrong body part or mixing up donor sperm for an artificial insemination would seem obvious fodder for a malpractice lawsuit and a settlement worth more than the bill for the procedure.

Other errors on the list, such as "retention of a foreign object in a patient after surgery" or patient injury associated with "contaminated drugs, devices or biologics provided by the health care facility," are probably more common and fixing them compounds the soaring cost of health care.

While it seems obvious that most consumers and many companies would support a don't-pay-for-errors approach, the industry is also expected to sign up given momentum in Washington and state governments to demand that care providers adhere to basic quality standards.

The seriousness of the errors on the group's list could make defending payments for these errors difficult and cause a political uproar if hospitals did not comply.

One hurdle to moving forward on this now is that few states require hospitals to report their errors. Although egregious errors like those on the list are considered rare, there were more than 100 never events reported by hospitals in Minnesota in its most recent reporting year.

In Illinois, state health officials are still working through the details on how hospitals will report such incidents under terms of a law signed last year.

There is, however, momentum to go beyond serious errors to consider more routine problems, such as hospital-borne infections and other quality issues, as part of the nationwide debate over paying medical-care providers based on performance.

Still, when such serious errors occur, the business community picking up the tab says patients should get an apology, and patients and their insurers or employers should not be billed. Such errors only add to health care costs that have spiraled upward for years. At least one study suggests that medical errors and low quality health care account for 30 percent of the more than $2 trillion spent on medical care in the United States.

"Never events are a symptom of a health care system that is broken and unresponsive," said Debra Ness, president of the National Partnership for Women & Families, a consumer advocacy group. "We look forward to working with employers to ensure that patients never have to bear the financial costs associated with never events, and to working with policymakers and consumers to prevent never events altogether."

The push by U.S. businesses comes as Congress and the Bush administration consider financial penalties for medical-care providers when such errors occur. Earlier this year, the Centers for Medicare and Medicaid Services, which run the nation's largest health insurance programs, said the agency would work with Congress to investigate potential ways to reduce reimbursement to providers that commit errors.

Although federal officials say the exact number of never events is unknown, the Centers for Medicare and Medicaid Services said they are costly to the system and believe they could number in the tens of thousands annually.

The agency cites the 1999 Institute of Medicine estimate that as many as 98,000 deaths a year "were attributable to medical errors, and recommended that error-related deaths be decreased by 50 percent over five years," the CMS says on its Web site.

But hospitals are committed to "making it right" with patients when they make mistakes, the industry's Washington-based lobby and trade group said. "We agree that these never events should never occur, and we are working hard to make sure they are not only rare, but more and more rare each day," said Richard Umbdenstock, president-elect of the American Hospital Association, which represents more than 4,800 of the nation's hospitals. "We certainly agree that when they do occur, and it can be tragic, we need to reach out and make it right."

But while the hospital group said it believed most hospitals would sign on to the Leapfrog Group's policy, it said there would be instances where "hospitals and patients" would have to work the situation out themselves, noting complexities of cases.

Health insurers say they are working clauses into hospital contracts that preclude them from being billed for never events and say there is momentum to apply that practice to lesser errors.

As of Jan. 1, 2005, Minneapolis-based health insurer HealthPartners Inc. required hospitals in its network to report errors to the state department of health and not bill its health plan members for a never event.

"We do see this as an important signal to the health care system about transparency and an expression of pay-for-performance," said Babette Apland, senior vice president of health care management for HealthPartners, a health plan with more than 600,000 members.

"To consumers, to people, this makes sense," she added. "I think it gives us the framework to stop payment when there is this type of extremely poor quality."

Bruce Japsen writes for the Chicago Tribune.

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