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Wednesday, Dec 7, 2022
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Anthem Says It Won’t Pay for Hospital Errors

Operating on the wrong body part, leaving surgical instruments in the body or allowing patients to develop ulcers during their hospital stays are just a few of the medical errors that result in an estimated 44,000 patient deaths per year in medical facilities throughout the nation. In what the company says is a bid to improve the quality of care hospitals provide to patients, Anthem Blue Cross recently announced that it will no longer reimburse hospitals for services that result in serious and preventable adverse medical events, also known as “never events.” “We are listening to our members, business coalitions, and our key accounts who want to know their health plan is looking out for them,” Anthem Blue Cross President Leslie Margolin stated. “As a strong advocate for patient safety, Anthem firmly believes that putting processes in place that focus on preventing these events can have an immediate impact on health care safety and quality.” This is the first phase of Anthem’s new initiative, which is modeled on a policy introduced by the Centers for Medicare and Medicaid Services (CMS) last August and criteria developed by the National Quality Forum in 2002. “CMS has piloted this first. What we’re doing is looking closely at CMS wanting to mirror those policies,” said Anthem Blue Cross Chief Medical Officer Dr. Zeinab Dabbah. “We’re still working on details for the process of reaching out to various physician groups.” In light of the new initiative, no one will be charged if surgery is performed on the wrong body part or on the wrong patient or if the wrong surgery is performed on the right patient. Moreover, there will be no additional charges if objects are left in the body during surgery, there is an air embolism or blockage, blood incompatibility or a hospital-acquired injury. The same is the case if certain kinds of infections or ulcers develop during a hospital stay. The goal is to help protect Anthem Blue Cross’s eight million members from additional payments resulting from these errors, according to the company. Dabbah said that preventable errors can cost about $4,700 per day. “Not only are we paying for the cost, but the premiums go higher.” In some instances of adverse events, both the hospital and the physician are responsible, such as when surgery is performed on the wrong patient. In others, such as when a patient develops an ulcer from being stationary at length, only the hospital would be responsible. Asked how much money Anthem can expect to save in light of its new policy, Dabbah balked. “I hope we don’t save a penny,” she said. “These things should never happen. We never did any financial analysis. If the facilities or physicians do the right thing, there would be no money saved.” This begs the question: Why aren’t hospitals already striving to prevent medical errors? Dabbah agreed that hospitals should always aim to prevent medical mistakes. Yet, she said, the fact that medical error kills more people per year than the number who die on highways means that greater action needs to be taken. “They’ve made great progress, but somebody needs to be more accountable,” Dabbah said. “That will make people put more money into preventing the errors.” Dabbah isn’t alone in that view. Assemblyman Mike Feuer is so concerned about preventable medical mistakes that he introduced a bill that would make a policy such as the one Anthem has adopted law. Thus far, Dabbah said that Anthem has had virtually no resistance to its new reimbursement policy. “I’ve been very pleasantly surprised,” she said. “We’ve only gotten positive feedback, whether from facilities or physicians. I haven’t had any negative feedback.” In the period leading up to Anthem’s announcement about its new policy, the company made a series of waves in the area of medical error prevention. It has included patient safety metrics in its Quality-in-Sights Hospital Incentive Program and in its Member Health Index program, the first program in the industry to track and compare the collective health of all health plan members based on 20 clinical areas and 40 separate component measures, according to the company. Anthem has also supported the Institute for Healthcare Improvement’s Million Lives campaign, a voluntary initiative to protect patients from medical harm through December 2008. Lastly, the company has participated in Leapfrog’s patient safety survey to reduce preventable medical mistakes and improve the quality and affordability of health care. The steps Anthem has taken in the realm of medical error prevention have elicited praise from the National Patient Safety Foundation. “Anthem Blue Cross’ efforts to concentrate on patient safety and work toward eliminating avoidable hospital errors are commendable and commensurate with our goals for a safer health care system that must realign itself to pay on the basis of safety and quality,” NPSF President Diane Pinakiewicz stated. “It is important that our industry find ways to correct the systems issues that allow avoidable errors to occur, and Anthem Blue Cross’s leadership in the field will help move us in this direction.”

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