Group calls on hospitals to waive payments for "never events"

A coalition of the nation's largest employers is asking hospitals in every state to adopt a policy that would prohibit billing the victims of so-called "never events" for the costs of care.

Last month's announcement from Leapfrog Group, a Washington, D.C.-based coalition of the nation's largest corporations and public agencies, came soon after the National Quality Forum's revision of a 28-item list of medical errors so egregious that they should never occur, thus the term "never events." Those include operating on the wrong patient or body part, and leaving a foreign object inside a patient after surgery.

The NQF, a private organization whose members include the American Medical Association, is not involved in the Leapfrog initiative.

Leapfrog plans to recognize hospitals that adopt the policy through its 2007 Hospital Quality and Safety Survey.

Rachel Weissburg, program associate for Leapfrog, said the policy incorporates procedures that most hospitals have in place already, such as reporting the incident and performing a root-cause analysis.

Leapfrog's move to block payment was not motivated by financial reasons, Weissburg said, but was added simply because "that's the least [the hospitals] can do. We just want to make that explicit."

In 2003 Minnesota became the first state to pass a never-events law that required the reporting of every never-event occurrence. Five other states, California, Connecticut, Illinois, Indiana and New Jersey, also have passed similar reporting laws or policies.

In 2004, one of Minnesota's largest insurers, HealthPartners, took the state policy one step further and announced that it would not reimburse for any procedure involved with a never event.

Richard Geier, MD, president of the Minnesota Medical Assn., said the society had been opposed to HealthPartners' policy and that the association's criticisms apply to Leapfrog's policy as well.

"They are trying to do something useful, but their answers are too simplistic and not evidence-based," Dr. Geier said.

Dr. Geier said the withholding of payment is a "use of the new reporting system that was never intended."

Geier said the medical society feels that the policy turns the situation into a punitive one and "interferes with what we're trying to do," which is to learn why and how these events occur and how to prevent them.

But if an egregious error did occur, "we would not rub salt in the patient's wounds by asking them to pay," he said.

Bernard Emkes, MD, a family physician and former president of the Indiana State Medical Assn., said the billing question isn't as black and white as Leapfrog makes it out to be.

"When an event occurs that is clearly identified as a mishap, all charges for that procedure clearly should be absorbed. But that doesn't mean all charges are written off," Dr. Emkes said.

For example, he doesn't think that the event automatically should mean that all fees associated with the patient's hospital stay should be absorbed, especially if the patient was given great care before the mishap or had other health issues associated with the hospital stay.

Rich Umbdenstock, president-elect of the American Hospital Assn., said Leapfrog's policy "articulates what many hospitals are already doing -- apologizing to patients and working to do the right thing for them and their families." He said the AHA also agrees that patients should not have to pay for costs directly related to the event and that "hospitals should recognize patients' unique circumstances and work with them."

Mohit M. Ghose, spokesman for America's Health Insurance Plans, said it remained to be decided how each insurance plan would approach the issue. But there seems to be overall support of public reporting and payment structures that reward for quality performance, he said.