Aug 26 2009
Aetna (NYSE:AET) is strengthening its efforts to promote patient safety with easy-to-find online information for members. New policies also require health care facilities, physicians and other health care professionals to take action to prevent medical errors and changes the way they are paid when medical errors do occur.
“We are mindful that every health care professional and facility intends to provide the best possible care. Still, as many as 98,000 people die each year from preventable medical errors,” says Lonny Reisman, M.D., Aetna’s chief medical officer. “We are giving members more information to help them promote their own safety. At the same time, we are pairing safety with policy requirements that promote patient safety vigilance among health care facilities and physicians.”
More information for members
Aetna’s member website, Aetna Navigator™, now features patient safety information to help members protect themselves from medical mistakes. The information is featured in the “Take Action on Your Health, Health Guide” section where members are more likely to research information in preparation for health care procedures.
Members can print out a checklist of tips before they go to the doctor or hospital. If they follow the tips they can help prevent many errors, from medication mistakes to wrong procedures. For example, before getting blood, treatment or medication in a hospital setting, patients should ask the health care professional to check their ID bracelets. Before having surgery, a patient should ask the surgeon to mark the correct and incorrect sides of her body with a magic marker.
Promoting patient safety
Aetna also has established new policies regarding Serious Reportable Events (SREs). SREs are conditions, such as leaving a foreign object in a patient after surgery that could reasonably have been prevented through application of evidence-based guidelines. SREs include events that should never occur in health care, so-called “Never Events.” These include performing the wrong surgery or surgery on the wrong person or the wrong part or side of the body.
A list of 28 serious reportable events (which include Never Events) was first established by the Leapfrog Group, and endorsed and further refined by the National Quality Forum (NQF), a not-for-profit organization created to develop and implement a national strategy for health care quality measurement and reporting.
Aetna’s new policies require health care facilities to take the following steps to identify improvements in care processes to prevent future events when any of the 28 SREs occur when caring for an Aetna member:
- Notify Aetna and at least one of the following agencies: The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO), a state reporting program for medical errors; or a patient safety organization
- Perform analysis to understand the basic or causal factors and identify improvement to the facility’s patient care systems and processes
- Communicate with the affected member and/or member’s family about the event
These steps are consistent with the recommendations of the Leapfrog Group, NQF, JCAHO and the National Business Group on Health.
Additionally, facilities, physicians and other health care professionals will be required to waive all charges related to the three Never Events. Health care facilities will also be required to waive charges that are directly and solely related to eight other specific SREs. Aetna wants to protect members financially in these situations as well, and does not allow providers to bill members for charges related to these events.
When Aetna is notified of an SRE, Aetna medical directors will contact the facility or health care provider to review the event and discuss the appropriate payment given the circumstances. Notification also initiates Aetna’s own quality improvement actions with the facility or health care professional and facilitates necessary follow-up care for members through care management programs.
“We’re not simply asking health care providers to waive payment for medical errors; we’re asking them to engage with us to increase patient safety. We want this to be a collaborative process,” Reisman says.
The new policies apply to all claims in Aetna commercial medical products and in-network claims in Medicare Advantage plans. The policies do not apply to out of network Medicare Advantage claims, or fee-for-service Medicare, which follow Centers for Medicare & Medicaid Services (CMS) rules.
“Aetna’s focus on quality and improvement through collaboration, while protecting members and plan sponsors from the financial costs of medical errors, is an important step forward for health care,” said Leah Binder, president of the Leapfrog Group. “Aetna’s industry leading reimbursement policies for Never Events and SREs will help all the parties come together more effectively to make lasting improvements.”
Aetna was the first health plan to endorse the Leapfrog Group’s approach to “Never Events,” including public recognition of hospitals that voluntarily develop procedures around reporting these events. Aetna reaffirms its reimbursement policies by continuing to include language regarding responsibility in reporting these events as part of its hospital contract.
http://www.aetna.com/index.htm
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