State wont pay for hospital errors
While Pennsylvania no longer will reimburse hospitals for medical costs related to some preventable errors, it appears the new rule will initially apply to one-third of the more than 40,000 Bucks County residents receiving medical-assistance benefits.
As part of Gov. Ed Rendell’s �Prescription of Pennsylvania� health reform package, the new policy is designed to improve patient care and help reduce medical care costs. It follows a similar policy the federal government implemented with its Medicare patients last year.
The no-payment policy took effect last week and covers 27 types of preventable medical errors resulting in injury or death, ranging from medication mistakes and patient falls to surgery on the wrong body part and suicide.
Local hospital representatives expressed support for the new policy that was developed with input from a state organization representing their interests. They hope it includes financial incentives that will help hospitals cover expenses related to reducing errors.
�Hospitals, we’re getting used to the fact that our increases in Medicare [reimbursement] go up 2 or 3 percent yet our cost of operating goes up between 7 and 9 percent,� said Austin Cleveland, president and CEO of Lower Bucks Hospital in Bristol Township.
A 1999 report of the Institute of Medicine suggested between 44,000 and 98,000 people die in hospitals each year as a result of medical errors, making it the eighth leading cause of U.S. deaths, resulting in an estimated $38 billion in health care costs.
The new Medicaid nonpayment policy is limited. The error must be preventable and within the control of the hospital, it must occur during the hospital stay and it must result in significant patient harm.
Also, it only applies to people in the fee for service program, which represent roughly one-third of the 2 million Pennsylvanians enrolled in Medicaid, welfare department spokeswoman Stacey Witalec said. In Bucks County, it could affect roughly 15,000 of the 41,855 Medicaid beneficiaries.
She added the state is working with its managed-care organizations that provide Medicaid coverage to implement similar no-pay policies in the near future.
The Hospital %26amp; Healthsystem Association of Pennsylvania, which helped write the policy, says the errors it covers are within a hospital’s control to prevent.
�Hospitals are doing everything they can to prevent these types of events from happening and, until we can completely eliminate them, we don’t think medical assistance should pick up the tab,� added Priscilla Koutsouradis, spokeswoman for the Delaware Valley Healthcare Council, which represents Philadelphia area hospitals.
There were roughly 115,000 Medicaid inpatient admissions in the 2006-07 fiscal year, but it is too early to determine what portion involved preventable errors resulting in harm, Witalec said.
Hospitals typically take one to two months to submit bills, and once the state identifies potential preventable errors there will be a medical review. �It will be a number of months before we will know actual dollars withheld for these events,� Witalec added.
The state agency responsible for monitoring hospital errors and near misses says the frequency remains a problem.
�We can’t say we’ve seen significant improvement in these areas,� added Bill Marella, the reporting system project manager of the Pennsylvania Safety Authority.
In 2006, 464 Pennsylvania health care centers submitted 195,832 error reports, an increase of nearly 26,000 reports over the previous year. About 96.5 percent of these reports involved incidents that did not result in patient harm. The remaining 3.5 percent were �serious events� where the patient received some level of harm, ranging from minor and temporary to death.
DisplayAds (’Middle’);Among the authority’s other error findings:
Last year, Pennsylvania hospitals reported 363 patient falls, 70 wrong site surgeries and 60 medication errors, all resulting in serious patient harm.
Between June 2004 and October 2007 more than 1,700 hospital reports were filed related to methicillin-resistant Staphylococcus aureus, including 14 deaths.
Between June 2004 and December 2006 the authority received 174 reports of patients who received wrong site surgeries and another 253 reports of near misses.
One area where the authority has seen improvement is public expectation that many errors can be prevented, Marella added. Five years ago, hospital-acquired infections were seen as the �cost of doing business,� but that isn’t the case anymore.
Last year, the Medicare program, the health program for the elderly, announced it would no longer pay hospitals the costs related to eight preventable errors, such as when objects are left in patients during surgery.
Private health insurers also are implementing no-pay policies involving medical procedures in which errors occurred, Marella said.
Last week, Aetna, the Philadelphia region’s second largest commercial insurer, announced it would no longer pay for patient care resulting from some preventable medical errors, such as surgery on the wrong body part or patient and discharging an infant to the wrong person. The new clause will be part of the insurer’s new or renegotiated hospital contracts.
Local hospital officials pointed out they’ve taken major steps in recent years to develop systems and practice models that address medical errors and prevent them. They’ve noted hospitals have seen large drops in hospital-acquired infection rates.
Still, mistakes happen, added Dorothy Carey, vice president of patient care services at Lower Bucks Hospital. She worries about the impact no-pay error policies will have on financially struggling hospitals like hers.
�Unfortunately, certain things happen,� she said.
Many errors are within a hospital’s control, but some � particularly those involving infections � might not be, added Dr. Doron Schneider, associate patient safety officer Abington Memorial Hospital.
�This is just one more pressure on our system,� he added.
No reimbursement
Pennsylvania hospitals will not be reimbursed for these preventable medical errors:
Wrong surgical procedure
Use of contaminated drugs or devices
Patient suicide or attempted suicide resulting in serious disability while hospitalized
Medication errors
Death associated with a fall while hospitalized
Unexpected removal of organ or limb
Administering incompatible blood or blood products
Death or serious disability associated with labor and delivery of low-risk pregnancy
Severe allergic reaction
Leaving a foreign object inside a patient
New pressure ulcers acquired after admission
Source: State Department of Welfare
Jo Ciavaglia can be reached at 215 949-4181 or jciavaglia@phillyBurbs.com.
