Never-Events

Private health insurers have jumped on the band wagon when it comes to not paying for preventable injury or illness occuring through hospital errors. Medicare instituted non-payment of errors last October.

Aetna, Wellpoint, and some other large insurers are starting with a shorter list than Medicare’s so-called ‘never-event’ list. Primarily focused on the most egregious errors such as bed sores, falls and hospital infections, the list could expand quickly as these initiatives are implemented.

The idea is that insurers will no longer pay for mistakes, and hospitals cannot bill patients directly for the cost of care associated with fixing these problems, in an attempt to improve patient safety. But is that going to be the outcome? What about the patient who, say, has a sponge left inside after an operation? Will a procedure be performed gratis to remove it, or will it simply be left there instead?

If insurers are truly seeking to improve safety and lower the overall costs of care, it strikes me that responding punitively is not the right answer. Rather, why not help support safety by paying for screenings that help identify MRSA in patients coming in to the hospital, and reward those hospitals that have significantly fewer errors over time.

Indeed, every effort should be made to prevent errors in the first place, so shouldn’t the focus be on paying for preventive measures rather than on not paying for fixes when they occur?

Otherwise, this will just become another reason for insurers to not pay for needed care which will cycle through the system adding more expense elswhere. Meanwhile patient welfare may be compromised when things go wrong, which can only exacerbate the problem going forward.