Blue Cross Adopts Policy to Deny Payment for Medical Errors

Blue Cross Blue Shield of Michigan has formalized a policy that will deny payment to hospitals that commit nine medical errors considered preventable.

The policy on serious medical events, which goes into effect October 1, follows a similar policy announcement made this year by the federal Centers for Medicare & Medicaid Services.

Blue Cross officials said the new policy is consistent with existing hospital and provider contracts that do not allow payment for medically unnecessary services regardless of cause.

The medical errors in CMS’ policy include objects left in a body after surgery, air embolism following surgery, blood incompatibility, equipment-associated infections, advanced pressure sores and hospital-acquired injuries, including falls and burns.

In addition to those six, the Blues added three others: surgery on the wrong patient, surgery on the wrong body part and wrong surgery.

In developing its policy, Blue Cross consulted a number of physician and hospital organizations in Michigan. The Michigan Health and Hospital Association, a Lansing-based group that represents the state’s 146 hospitals, has also created a similar policy on billing for preventable errors.

Medicare also is taking comments on adding another nine conditions to its medical error nonpayment list. The additional conditions will be effective in October 2009.

Those additional conditions will include surgical site infections, septicemia, ventilator-associated pneumonia, delirium, Legionnaires’ disease and pulmonary embolism.

Eventually, Medicare is expected to adopt all 28 preventable medical errors identified by the National Quality Forum, a Washington-based coalition of employers and health care organizations.

Medicare has cited studies on 18 types of medical errors that accounted for 2.4 million extra hospital days, $9.3 billion in excess charges and 32,600 deaths.

Filed by Jay Greene of Crain’s Detroit Business, a sister publication of Workforce Management. To comment, e-mail editors@workforce.com.