The large employers, who compose the board for the National Business Group on Health, will no longer pay for medical claims for avoidable medical errors, says Helen Darling, president of the Washington, D.C.-based group. Preventable medical errors lead to between 44,000 and 98,000 deaths each year and cost as much as $30 billion, a number that includes lost productivity.

While much of the information on the cost of medical errors came to light in 1999 with an Institute of Medicine report titled "To Err Is Human," Darling says employers have grown frustrated with the lack of substantial progress.

"The health industry has worked on this the last five years, but they have not moved fast enough," Darling says. "Costs keep going up, but care is not necessarily getting better."

Darling urges all employers to follow the group’s guidelines. Employers should insist that their health plans negotiate contracts that force medical providers to follow established guidelines on patient safety in order to be included in the preferred provider networks, which form the basis of PPO and high-deductible plans.

There are two initiatives that have improved standards of care at both hospitals and within medical practices, and medical providers should become active in both to remain in an employer’s preferred provider network, Darling says. One is the 100,000 Lives Campaign, a program launched by the Institute for Healthcare Improvement to reduce avoidable hospital deaths; the other is the Surgical Care Improvement project, a set of standards intended to reduce surgical complications and deaths 25 percent by 2010.

Employers should also insist that doctors and hospitals adopt electronic medical records and personal health records for each patient, though no timetable was laid out for when that should happen and who would pay for it. Medial providers should "demonstrate a commitment" to such goals, Darling says.

If medical providers in an employer’s network do not make a commitment to improve patient safety, employers should insist the providers be kicked out of the preferred network. Because preferred networks rank doctors and pay those who rank higher more money, doctors have a financial incentive to follow improved standards of care, Darling says.

Despite the pronouncements, the program may not accomplish much, says Michael Millenson, a health care expert and author of Demanding Excellence, a seminal book on hospital safety. That’s because a majority of U.S. hospitals already adhere to the standards created by the 100,000 Lives Campaign. Despite employer demands for improved safety, many providers may already meet the standards to be set out by the National Business Group on Health.

"We have to get past the point where declarations of intent are sufficient," he says.

The National Business Group on Health has 250 members, but Darling could not say whether all members would adopt the board’s call to action. Darling, who has met with the five major health plans to get their support, anticipates that the new preferred network standards will take effect on a rolling basis beginning in February 2007.

--Jeremy Smerd