Blue Cross: No pay for medical errors

Posted on Apr 8, 2009 in Health & Wellness

By Alan M. Wolf
(Raleigh) News & Observer
Posted: Wednesday, Apr. 08, 2009
Blue Cross and Blue Shield, the state’s largest health insurer, will no longer pay hospitals for problems caused by preventable medical errors, under a new policy announced Tuesday.The policy is designed to improve patient safety and reduce medical mistakes. The details were developed by Blue Cross with the N.C. Hospital Association, which has 130 members across the state.

“It goes to the old saying, ‘What gets counted gets improved,’ ” said Don Dalton, a spokesman with the N.C. Hospital Association. The trade group expects that other insurers that operate in the state will adopt similar policies.

Indeed, the policy follows a broader industry shift led by Medicare, which last year began refusing to pay for preventable errors to save money and improve patient safety.

“It’s silly to pay for things that shouldn’t have happened in the first place,” said Adam Searing, a health-care advocate with the N.C. Justice Center. “This is where our payment system is moving.”

Under the Blue Cross plan, the insurer will not reimburse hospitals for errors such as procedures done on the wrong side of the body or on the wrong patient. If a patient falls in a hospital or develops a bedsore while admitted, the hospital will be responsible for the cost, said Don Bradley, chief medical officer at Blue Cross.

“Putting financial disincentives in there is a powerful motivator,” Bradley said.

Bradley does not expect the policy will put patients in the middle of billing disputes.

But he emphasized that patients should always take an active role in making sure they’re getting the proper care and review bills carefully. Blue Cross will monitor its own records for problems, but it also will rely on patient complaints. The insurer has 3.7 million members.

In reality, most hospitals have their own policies for preventing medical errors. And Blue Cross previously refused to pay for mistakes. The new policy sets formal rules to reduce confusion.

The insurer will publish more details about its policy, including a list of “adverse patient events” it will no longer pay for, on its Web site,