Blue Cross and Blue Shield of Massachusetts & Massachusetts prohibit hospitals and doctors from billing for costs relating to fixing medical errors

"State, insurer bar billing to fix medical errors"
The Associated Press
Thursday, June 19, 2008

BOSTON (AP) — The state and its largest private health insurer have announced policies that prohibit hospitals and doctors from billing for costs relating to fixing medical errors.

Health policy analysts say the directives outlined separately yesterday by the state and Blue Cross and Blue Shield of Massachusetts increase the pressure on hospitals to eliminate mistakes and improve the quality of care.

The state and Blue Cross policies apply to 28 types of surgical, medication, and other errors identified by a national coalition. They include operating on the wrong limb and giving the wrong dose of medication.

Jim Conway, senior vice president of the Institute for Healthcare Improvement, says 70 such errors were reported to the state in the first five months of this year.

The changes are part of a national effort.
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Information from: The Boston Globe, www.boston.com/globe
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"Medical mistakes no longer billable: Bold steps taken by state to reduce hospital errors"
By Stephen Smith, (Boston) Globe Staff, June 19, 2008

Hospitals and doctors who operate on the wrong limb or give a dangerous dose of medication will no longer be able to bill the state of Massachusetts or its largest private health insurer for costs related to fixing the error, health authorities announced yesterday.

The policies outlined separately yesterday by state government and Blue Cross and Blue Shield of Massachusetts have the potential to influence the care of about 4 million people in the state and substantially increase the pressure on hospitals to improve the quality of care.

Independent health-policy analysts said the move by Massachusetts to restrict reimbursements represents the boldest attempt by any state to use payments to reduce life-threatening errors that are considered preventable.

The state helps fund care of the poor, government employees, prisoners, and formerly uninsured patients who have purchased subsidized health plans as part of the drive to provide near-universal health insurance.

No other state "has taken the level of leadership on this issue that Massachusetts is demonstrating," said Leah Binder, chief executive officer of the Leapfrog Group, a national coalition of employers that advocates for healthcare improvement. "The reason we think this is important is that it creates an incentive for hospitals to put more resources toward creating a culture of safety, to doing the kinds of things that are necessary to prevent human error from taking the lives of patients."

The state and Blue Cross policies apply to 28 types of surgical, medication, and other errors identified by a national coalition. The policy changes by the state are part of a national effort to reduce healthcare errors. The federal Medicare program announced last year that it would stop paying for medical errors.

Andrew Dreyfus, executive vice president for Blue Cross, said last night that the company had been working on its policy for about 18 months, deciding "that while these events are rare, many of them can be prevented."

"We ought to be paying for care that's safe and effective and high quality," he said.

In a study published in 2006 in the journal Health Affairs, researchers estimated the extra cost of treating serious errors ranged from an average of $700 per case for preventable bed sores, to an average of $9,000 per case for body-wide infections after surgery.

State authorities had no estimate on how much in additional fees they had been paying because of errors, in part because the Department of Public Health only recently began mandating that hospitals and doctors report serious medical mistakes.

In the first five months of this year, 70 such errors were reported to the state, according to Jim Conway, senior vice president of the Institute for Healthcare Improvement, a Cambridge think tank that works with hospitals to improve safety and efficiency.

Tom Dehner, director of the state's Medicaid program, said the initiative is not, at its core, "an effort to save money by taking reimbursement away from hospitals."

"It's an effort to say to hospitals that we as state purchasers don't believe we should reimburse you for egregious errors," Dehner said.

"We expect to pay for quality healthcare," he said, "and want to work with our providers to make sure our patients get that."

Many details about the policy's implementation and how it will be enforced remain to be spelled out, Dehner acknowledged in an interview. The state Medicaid program, known as MassHealth, for example, processes 6 million claims a month, and it is unclear how the state could scour all those records for evidence that it was being asked to pay for treatment related to a serious medical mistake.

The state reimbursement policy will start going into effect as contracts are renegotiated under the various state health plans.

The chief executive officer of the three-hospital Southcoast Hospitals Group, Dr. Ron Goodspeed, said the state's quest to tie reimbursement to quality care reflects trends being driven by administrators, insurers, and regulators, and will ensure greater consistency in payment policies.

"Rightfully, people feel they shouldn't be having to pay for medical care that's needed because it was caused by a medical miscue," said Goodspeed, who is also president of the Massachusetts Coalition for the Prevention of Medical Errors. "It's almost like if you're getting your transmission fixed and the repairman accidentally cuts your brake line, you wouldn't expect to pay for the brake line repair."

In recent months, hospital administrators have begun pledging not to charge insurers, public or private, for medical errors, saying they should absorb the costs of their own errors.

The state's largest confederation of healthcare institutions, the Massachusetts Hospital Association, said in November that all its members had embraced a uniform policy of not charging patients or insurers for nine serious errors, including surgery on the wrong patient, operating on the wrong body part, or giving an infant to the wrong family.

The president of the association, Lynn Nicholas, said yesterday that the group supports the direction of the state's initiative but has concerns about details. The state rules, for instance, ban payment if a patient suffers serious injury or dies because of a contaminated medical device.

"But what if there's a device contaminated by the producer or that comes with faulty instructions?" Nicholas said. "Should the hospital not be paid for something they could not have prevented, that was not within its control?"
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Stephen Smith can be reached at stsmith@globe.com.
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The Boston Globe - Letters
"Hold hard line on medical errors"
June 24, 2008

KUDOS TO the Patrick administration for taking the first step toward health reform that potentially benefits all Massachusetts residents ("Medical mistakes no longer billable," City & Region, June 19). The Commonwealth has begun the process of applying the same standard it uses for buying staplers to buying healthcare services. If it's substandard, don't pay for it.

Refusing to pay for preventable events that usually cause death or serious disability will add to pressure to eliminate these avoidable errors. It is crucial to expand the list to far more common preventable medical errors that can be just as deadly.

Patients, taxpayers, and premium payers need to keep their eyes wide open as this process moves forward. It's a fundamental test of political priorities. Who comes first: Bay Staters or hospitals and insurers?

If the Commonwealth gets bogged down implementing a policy that many hospitals and the state's largest private insurer have already voluntarily adopted, or if taxpayers and premium payers don't see their fair share of the savings that come with reduced error rates, we have a major problem with priorities.

BARBARA WATERS ROOP, Co-chairwoman
Health Care for Massachusetts, Cambridge, Massachusetts

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(A Boston) GLOBE EDITORIAL
"Better data for better health"
July 3, 2008

BLUE CROSS Blue Shield of Massachusetts announced an agreement recently to give members access to their records via the new Google Health service. This venture is part of a movement to put consumers in charge of their medical records as the healthcare system edges into the Internet era. It's unclear, however, whether patients want this control. What's more important is getting doctors and hospitals connected into a single system. Blue Cross is doing its part by financing an experiment in three Massachusetts communities.

Google Health, like similar services from Microsoft and other companies, is voluntary. Patients will be able to store and check their records for accuracy, and if they move to another doctor, allow access via Google. Google and the other companies have agreed to privacy guidelines, but they are not covered by the federal law that protects health records held by physicians, hospitals or insurance companies. Patients should be wary of this legal void.

The private companies are taking the lead on electronic health records because of the failure of many US healthcare providers to embrace the Internet. A system should be in place that, subject to patient approval, would speed records from physicians' offices to hospitals or anyplace a person needs care.

Healthcare providers would know which drugs a patient is taking and what tests have been done. Guided by Internet-based information services, physicians would offer treatment that reflects the latest medical knowledge. All this could be done without compromising patient privacy. Data-sharing among doctors and hospitals is protected by federal law and, in Massachusetts, state privacy requirements.

Partners HealthCare and a few other regional providers have connected their hospitals with allied physician groups. These networks are isolated and small compared with the need. A recent study in the New England Journal of Medicine found that only 4 percent of US physicians are linked to a comprehensive system.

In Massachusetts, the most impressive program is the eHealth Collaborative, which has established pilot programs in North Adams and Newburyport, and is just starting one in Brockton. Blue Cross Blue Shield, with a $50 million, four-year contribution, is the prime source of support.

In Newburyport, 100 physicians, with 100,000 patients, are hooked into a network with the Anna Jacques Hospital. In North Adams, 55 physicians and 40,000 patients are connected to the North Adams Regional Hospital. Patients must agree in advance that records are shared. The collaborative won't be able to assess the impact for a year or two, but if computerization in other sectors of the economy is a guide, the system will improve the quality, safety, and affordability of care.

The Blue Cross grant runs out on December 31, when there will still be much work to be done in the three communities. The state budget agreement reached this week includes $25 million to advance the creation of these systems. The budget doesn't specify who should get the money, but based on its success so far, the eHealth Collaborative deserves state support to identify other communities that would be willing to implement a health records system.

The $25 million won't buy much software or many computers. It will lay the foundation for a more expensive program requiring a combination of public and private funds.

Patients in Newburyport and North Adams will be able to access their own electronic records by the end of the summer. Then they can send them on to Google Health or another Internet service if they like. Closer to home, physicians and hospitals will already have the information they need to give them quality care.

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