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Blue Cross and Blue Shield of Texas Develops Policy to Promote Patient Safety and Stop Reimbursement for 'Never Events,' 'Serious Hospital Acquired Conditions'

Monday, July 21, 2008 General News J E 4
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RICHARDSON, Texas, July 21 Officials at Blue Cross andBlue Shield of Texas (BCBSTX) have announced, as part of its continuing focuson promoting patient safety and cost-effective, quality health care, a newpolicy to address a prominent issue in the healthcare industry -- "serioushospital acquired conditions" and "never events" (errors in patient care thatcan and should be prevented). The new policy means it is BCBSTX's intent notto pay the additional costs resulting from hospital-based preventable medicalerrors.

In recent months, the healthcare industry has engaged in discussions aboutpayment for so called "Never Events." As defined by the National QualityForum (NQF, a non-profit membership organization created to develop andimplement a national strategy for health care quality measurement andreporting), "Never Events" are adverse events that are serious, but largelypreventable, and of concern to both the public and health care providers forpurposes of public accounting. "Never Events" earned that name because theseevents should never happen in medical practice.

"Partnering with the hospital community is the best approach to addressthe systemic issues involved in preventing medical errors before theyunnecessarily threaten a member's health and add to the cost of care," saysDr. Eduardo J. Sanchez, vice president and chief medical officer of BCBSTX."Our goal is to continue to develop innovative outcomes-based programs thatreward or recognize hospitals for providing quality care and promoteprevention of medical errors."

In coordination with the Texas Hospital Association (THA), BCBSTX willapply five principles or guidelines when a "serious hospital acquiredcondition" or "never event" occurs, involving determination, by a medicaldirector, whether the event was preventable, within control of the hospital,the result of a mistake and resulted in significant harm to the patient.These principles will be applied to hospital acquired conditions identified bythe Centers for Medicare and Medicaid Services (CMS) as well as to nine NQFnever events to determine whether reimbursement to the hospital should bereduced for the additional costs related to the event. The nine NQF eventsare:

"We are pleased to collaborate with Blue Cross in promoting hospitalsafety and adoption of new billing policies that address this issue," said DanStultz, M.D., FACP, FACHE, president/CEO of the Texas Hospital Association."As the Texas Hospital Association joins the American Hospital Association andother state associations in adopting guidelines for voluntary discounting orwaiving of payment for care associated with serious, adverse events, we lookforward to cooperation among all facets of the health care industry. We alsoanticipate that this joint commitment to improve patient safety will supportcurrent efforts that are underway to develop national standards to minimizeadministrative costs and create uniform expectations for all hospitals andpayers."

Dr. Sanchez emphasized that BCBSTX's primary objective is patient safetyand quality medical care within the large Blue Cross network of hospitals.

Blue Cross and Blue Shield of Texas -- the only statewide, customer-ownedhealth insurer in Texas -- is the largest provider of health benefits in thestate, working with nearly 40,000 physicians and 400 hospitals to serve4 million members in all 254 counties. Blue Cross and Blue Shield of Texas isa Division of Health Care Service Corporation (HCSC), the country's largestnon-investor-owned health insurer and fourth largest health insurer overall.HCSC is a Mutual Legal Reserve Company and an Independent Licensee of the BlueCross and Blue Shield Association.1. Surgery performed on the wrong body part. 2. Surgery performed on the wrong patient. 3. The wrong surgical procedure performed on a patient. 4. Patient death or serious disability associated with
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