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Payers Promote Patient Safety With $$ Penalties

Before I start today's post, I'd like to pay tribute to the late Sen. Ted Kennedy, who was unflagging in his support for universal health care (among other good causes) for four decades. That's a long time to carry a torch that so many others were trying to extinguish, and it underlines Sen. Kennedy's seriousness about providing adequate health care to every American. Whether or not you agree with his proposals for expanding the role of government in health care, his example deserves a moment of silence and reflection. Let us hope that our current elected representatives will finally achieve the dream of this Moses who led us so far, only to die before entering the Promised Land.

Now, on to the business at hand. Aetna has taken its commitment to safeguarding patient safety in hospitals a step further than it did a year and a half ago. Then, it included in its contract language terms that prohibited payment for three "never events" and 25 other egregious medical errors. Now it has flatly required providers to waive charges for the three never events--wrong surgery, surgery on the wrong person, and surgery on the wrong body part. In addition, Aetna says, "Health care facilities will also be required to waive charges that are directly and solely related to eight other specific SREs [serious reportable events]." Following the recommendations of the Leapfrog Group and the National Quality Forum, which drew up the list of SREs, as well as of JCAHO and the National Business Group on Health, Aetna is also requiring providers to notify Aetna and either the Joint Commission, a state reporting program, or a patient safety organization when a serious error occurs. It also wants hospitals to do a root cause analysis of the error and to communicate to patients and their families about it.

Aetna's effort follows similar moves by Medicare and parallels similar patient safety initiatives by several Blues Cross Blue Shield companies, including Wellpoint and Blues plans in Massachusetts, Illinois, and Texas. The question is, will these efforts improve safety or increase the likelihood that providers will try to hide their medical errors?

Providers have long shied away from admitting mistakes because of concern about malpractice suits. Perhaps because of that, and because of the ingrained culture of professional autonomy in medicine, patient safety did not improve much in the five years following the Institute of Medicine's 1999 report "To Err Is Human." And in the past six years, the Agency for Healthcare Research and Quality found, the number of "adverse events" in hospitals has risen about 1 percent per year.

Will punishing hospitals financially when they admit their errors change this? That seems unlikely, but help may come from another source. Some hospitals have found that when they communicate their mistakes to patients and try to do something about them, the number of lawsuits drops. The University of Illinois Medical Center in Chicago, which started taking this tack in 2004, has seen the number of suits against the hospital drop 40 percent, even as its number of procedures has risen 23 percent.

Whacking providers' revenues when they tell the truth won't encourage them to confess. But somehow, we have to stop rewarding them for their mistakes.