Cigna HealthCare will stop reimbursing hospitals for care when certain
medical errors occur, the managed care company said Thursday, April 17.
Bloomfield, Connecticut-based Cigna HealthCare joins a growing number of
insurers refusing to pay for preventable adverse events as defined by the
Centers for Medicare and Medicaid Services and the National Quality Forum.
Cigna’s policy says it will deny hospitals reimbursement for “never events”
and avoidable hospital conditions, when permitted under its hospital contracts.
The policy defines never events as surgical procedures performed on the wrong
side, wrong site, wrong body part or the wrong person. Avoidable or acquired
hospital conditions are those that a patient develops during a hospital stay and
that could have been avoided.
Cigna will not reimburse hospitals if any of the following occur:
• An object is left inside a patient during surgery.
• Air embolism or sudden artery blockage from air bubbles introduced
during surgery.
• Use of the wrong blood type during transfusions.
• Infections from urinary catheters.
• Pressure ulcers or bed sores.
• Vascular catheter-associated infection.
• Mediastinitis, an often-fatal inflammation of the lung tissue.
• Hospital-acquired injuries such as fractures, dislocations and
burns.
Indianapolis-based WellPoint Inc. and Hartford, Connecticut-based Aetna Inc.
implemented similar provisions this year. In August, CMS announced it would no
longer pay for some hospital mistakes beginning October 1, 2008.
The Leapfrog Group, a Washington-based consortium of large, national
employers focused on patient safety, supports such payment denials.
Filed by Kristin Gunderson Hunt of Business Insurance, a sister publication
of Workforce Management. To comment, e-mail editors@workforce.com.