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.