Blue Cross and Blue Shield of Texas Develops Policy to Promote Patient Safety and Stop Reimbursement for 'Never Events,' 'Serious Hospital Acquired Conditions'

Jul 21, 2008, 01:00 ET from Blue Cross and Blue Shield of Texas

    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 products. 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 hospitals. 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