July 10, 2008 |
2008-R-0412 | |
MASSACHUSETTS NON-PAYMENT POLICY FOR SERIOUS MEDICAL ERRORS | ||
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By: John Kasprak, Senior Attorney | ||
You asked for information on a recently announced Massachusetts policy concerning non-payment for serious medical errors.
SUMMARY
On June 18, 2008, Massachusetts officials announced that the state will refuse to pay for costs associated with medical errors. This policy makes Massachusetts the first state in the country to establish a uniform non-payment policy across state government. (Maine recently passed legislation making it the first state to prohibit health care facilities from charging for treatment to correct medical errors; see OLR Report 2008-R-0340 for more information on the Maine law.)
The Massachusetts policy will be implemented as health contracts are renewed with the state and will cover over 1.6 million people who receive coverage as state employees, Medicaid recipients, subscribers to health plans subsidized by the state under its health reform law, and prison inmates.
MASSACHUSETTS' POLICY ON NON-PAYMENT FOR MEDICAL ERRORS
On June 18, 2008, representatives from across Massachusetts state government, in their roles as health insurance purchasers and signatories to the state's HealthyMass initiative, announced plans to no longer pay for costs associated with certain serious reportable health care events. The state will also no longer permit their providers to bill members for these services. The new policy builds on a requirement by the Massachusetts Department of Public Health for hospitals to begin reporting serious errors to the agency.
This policy was developed and adopted by four state agencies: the Office of Medicaid (MassHealth), Group Health Insurance Commission, Commonwealth Health Insurance Connector Authority, and the Department of Correction. These entities believe that a uniform policy will establish incentives for providers to improve the quality and effectiveness of patient care. Through HealthyMass, the agencies will work to implement the policy with an advisory group that includes hospitals, physicians, health insurance plans, and consumer representatives. The agencies are exploring the alignment of payment policies for preventable complications, such as hospital-acquired infections and preventable readmissions. The new policy will be implemented in each state agency's next contract cycle.
The non-payment policy applies to the 28 serious reportable events identified by the National Quality Forum (NQF), a non-profit coalition of physicians, hospitals, business, and policy makers. These events are generally preventable and present serious concerns for consumers and health care providers. (Maine also adopted the NQF list in its legislation.)
The list of serious reportable events is as follows:
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. unintended retention of a foreign object in a patient after surgery or another procedure;
5. intraoperative or immediately postoperative preventable death of a patient classified as a normal healthy patient under guidelines published by a national association of anesthesiologists;
6. patient death or serious disability caused by the use of contaminated drugs, devices or biologics provided by a hospital or ambulatory surgical center;
7. patient death or serious disability caused by the use or function of a device in patient care in which the device is used for functions other than as intended;
8. patient death or serious disability caused by an intravascular air embolism that occurs while being cared for in a health care facility;
9. an infant's being discharged to the wrong person;
10. patient death or serious disability caused by a patient's elopement (disappearance) for more than four hours;
11. patient suicide or attempted suicide resulting in serious disability while being cared for in a health care facility;
12. patient death or serious disability caused by a medication error such as an error involving the wrong drug dose, patient, time, rate, preparation or route of administration;
13. patient death or serious disability caused by a hemolytic reaction due to the administration of incompatible blood or blood products;
14. maternal death or serious disability caused by labor or delivery in a low-risk pregnancy, labor and delivery while being cared for in a health care facility;
15. patient death or serious disability caused by hypoglycemia, the onset of which occurs while the patient is being cared for in a health care facility;
16. death or serious disability caused by failure to identify and treat hyperbilirubinemia (jaundice) in neonates prior to discharge;
17. stage 3 or 4 pressure ulcers acquired after admission to a health care facility;
18. patient death or serious disability due to spinal manipulative therapy;
19. patient death or serious disability caused by an electric shock while being cared for in a health care facility;
20. any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances;
21. patient death or serious disability caused by a burn incurred from any source while being cared for in a health care facility;
22. patient death caused by a fall by a patient who was or should have been identified as requiring precautions due to risk of falling while being cared for in a health care facility;
23. patient death or serious disability caused by the use of restraints or bedrails while being cared for in a health care facility;
24. any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist or other licensed health care provider;
25. abduction of a patient of any age;
26. sexual assault of a patient within a health care facility;
27. death or significant injury of a patient resulting from a physical assault that occurs within a health care facility; and
28. artificial insemination with the wrong donor sperm or donor egg.
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