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Old 07-04-2008, 09:27 PM
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Default Medical Mistakes No Longer Billable

Medical mistakes no longer billable


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.
http://www.boston.com/news/local/mas...nger_billable/
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Old 07-04-2008, 09:30 PM
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I never would have thought they billed for those mistake surgeries or the surgeries to fix the mistake :th_09403103:

I thought the hospital and surgeon just had to eat those errors.
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Old 07-04-2008, 09:39 PM
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Nope in fact, Medicare will not pay for any errors soon nationwide-surgical errors, med errors, bedsores and falls. I think it's September but honestly not sure of exact date.
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Old 07-04-2008, 09:43 PM
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Nope in fact, Medicare will not pay for any errors soon nationwide-surgical errors, med errors, bedsores and falls. I think it's September but honestly not sure of exact date.
Wow, I can definately understand the surgical and med errors, I pretty much understand the bedsores but falls? Wow sometimes they just can't be avoided. What about falls at home?
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Old 07-04-2008, 11:17 PM
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I agree that mistakes shouldn't be billed but I don't understand why anything that happens while hospitalized can't be billed. Doesn't have to be a mistake. If a CABG pt's stay is extended because he goes into CHF, it can't be billed.
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Old 07-04-2008, 11:20 PM
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I agree that mistakes shouldn't be billed but I don't understand why anything that happens while hospitalized can't be billed. Doesn't have to be a mistake. If a CABG pt's stay is extended because he goes into CHF, it can't be billed.
Dang! So is the patient billed for the CHF treatment that Medicare is not going to pay?
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Old 07-04-2008, 11:34 PM
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Nope, the hospital has to eat it.

No joke, we suspect that some people have been discharged with mild symptoms of a second problem, but nothing was said in the H&P. That way, when the pt returned a couple of days later, as far as Medicare was concerned it was a new problem.
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Old 07-04-2008, 11:36 PM
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That one I haven't heard. Every CABG patient goes into CHF post op. It's just not preventable.
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Old 07-04-2008, 11:36 PM
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Yeah, but not the day they're supposed to be discharged.
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Old 07-04-2008, 11:38 PM
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That's true.
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