Never Pay for Never Events

Would you pay more for car that’s defective than you would for one that’s works well? Of course not, but that’s pretty much how the health care payment system works.

But change is afoot. EOHHS Secretary Bigby announced today that the state, as both an insurer and a purchaser of health care, will no longer provide payment to hospitals for costs associated with Serious Reportable Events (often referred to as Never Events). In addition, patients cannot be billed for the Never Events. Click here for the state’s press release, issued in the framework of its Healthy Mass initiative, and the list of events.

The list of 28 Serious Reportable Events (SREs) comes from the National Quality Forum, a national organization with a broad range of members, including consumer groups.

The policy was adopted by MassHealth, GIC, the Connector, and the Department of Correction. Together, they cover 1.6 million Massachusetts residents. Although other states have recently implemented similar policies in their Medicaid programs, the Commonwealth claims to be the first to establish a uniform policy across state government.

A presentation at today’s Quality and Cost Council meeting pointed out that there were 214 SREs reported by MA hospitals to the Board of Registration in Medicine in 2007. They believe the events are under-reported and that the actual numbers are higher. Falls that resulted in death or serious injury comprised 55% of those reported, and 22% of the reported events were wrong site surgery/wrong patient surgery/wrong surgical procedure. While there are no firm cost figures attached to these events, clearly they add to time spent in a hospital and the amount and intensity of care provided.

Health Care For All and our Consumer Health Quality Council have been advocating for fundamental payment reforms, including ending payment for a broad range of preventable complications, including never events, preventable infections and readmissions, and others. The Secretary’s announcement stated that they will be pursuing this next, and EOHHS is already making progress on cutting payments for preventable readmissions. For both quality and cost control reasons, we hope the House version of the Senate President’s cost control bill (out in maybe 2 weeks) will move further in this direction.

UPDATE: Blue Cross will join the state in not paying for “never events.” Globe story here.
UPDATED UPDATE: You can download DPH’s presentation on hospital reporting of SREs here.
Deborah Wachenheim