RICHARDSON, Texas, July 21 /PRNewswire/ -- Officials at Blue Cross and
Blue Shield of Texas (BCBSTX) have announced, as part of its continuing
focus on promoting patient safety and cost-effective, quality health care,
a new policy to address a prominent issue in the healthcare industry --
"serious hospital acquired conditions" and "never events" (errors in
patient care that can and should be prevented). The new policy means it is
BCBSTX's intent not to pay the additional costs resulting from
hospital-based preventable medical errors.
In recent months, the healthcare industry has engaged in discussions
about payment for so called "Never Events." As defined by the National
Quality Forum (NQF, a non-profit membership organization created to develop
and implement a national strategy for health care quality measurement and
reporting), "Never Events" are adverse events that are serious, but largely
preventable, and of concern to both the public and health care providers
for purposes of public accounting. "Never Events" earned that name because
these events should never happen in medical practice.
"Partnering with the hospital community is the best approach to address
the systemic issues involved in preventing medical errors before they
unnecessarily threaten a member's health and add to the cost of care," says
Dr. Eduardo J. Sanchez, vice president and chief medical officer of BCBSTX.
"Our goal is to continue to develop innovative outcomes-based programs that
reward or recognize hospitals for providing quality care and promote
prevention of medical errors."
In coordination with the Texas Hospital Association (THA), BCBSTX will
apply five principles or guidelines when a "serious hospital acquired
condition" or "never event" occurs, involving determination, by a medical
director, whether the event was preventable, within control of the
hospital, the result of a mistake and resulted in significant harm to the
patient. These principles will be applied to hospital acquired conditions
identified by the Centers for Medicare and Medicaid Services (CMS) as well
as to nine NQF never events to determine whether reimbursement to the
hospital should be reduced for the additional costs related to the event.
The nine NQF events are:
1. Surgery performed on the wrong body part.
2. Surgery performed on the wrong patient.
3. The wrong surgical procedure performed on a patient.
4. Patient death or serious disability associated with intravascular air
embolism that occurs while being cared for in a facility.
5. An infant discharged to the wrong person.
6. Patient death or serious disability associated with a hemolytic
reaction due to the administration of ABO-incompatible blood or blood
7. Death or serious disability, including kernicterus, associated with
failure to identify and treat hyperbilirubinemia in neonates during the
first 28 days of life.
8. Artificial insemination with the wrong donor sperm or donor egg.
9. Patient death or serious disability associated with a burn incurred
from any source while being cared for in a facility.
"We are pleased to collaborate with Blue Cross in promoting hospital
safety and adoption of new billing policies that address this issue," said
Dan Stultz, M.D., FACP, FACHE, president/CEO of the Texas Hospital
Association. "As the Texas Hospital Association joins the American Hospital
Association and other state associations in adopting guidelines for
voluntary discounting or waiving of payment for care associated with
serious, adverse events, we look forward to cooperation among all facets of
the health care industry. We also anticipate that this joint commitment to
improve patient safety will support current efforts that are underway to
develop national standards to minimize administrative costs and create
uniform expectations for all hospitals and payers."
Dr. Sanchez emphasized that BCBSTX's primary objective is patient
safety and quality medical care within the large Blue Cross network of
Blue Cross and Blue Shield of Texas -- the only statewide,
customer-owned health insurer in Texas -- is the largest provider of health
benefits in the state, working with nearly 40,000 physicians and 400
hospitals to serve 4 million members in all 254 counties. Blue Cross and
Blue Shield of Texas is a Division of Health Care Service Corporation
(HCSC), the country's largest non-investor-owned health insurer and fourth
largest health insurer overall. HCSC is a Mutual Legal Reserve Company and
an Independent Licensee of the Blue Cross and Blue Shield Association.
SOURCE Blue Cross and Blue Shield of Texas