Company Committed to Protecting Members’ Health and Finances by Not Reimbursing Major Preventable Adverse Events
MILWAUKEE, April 2, 2008 /PRNewswire/ — Anthem Blue Cross and Blue Shield in Wisconsin announced today process changes for its hospital network to be implemented this year. The changes will include reimbursement modifications and are aimed at eliminating preventable adverse events as defined by the Centers for Medicare and Medicaid Services (CMS) and the National Quality Forum. These reimbursement modifications will help protect Anthem’s nearly 1 million members from additional payments resulting from these “never events.”
“Anthem’s primary focus will be to ensure that physicians and hospitals are using appropriate processes, technologies and strategies to address ‘never events’ and, ultimately, to enhance the quality of care delivered to hospitalized patients,” said Michael Jaeger, M.D., medical director for Anthem Blue Cross and Blue Shield in Wisconsin. “We will continue to work collaboratively with physicians and hospitals to analyze why and how these events have occurred, and to proactively find ways to improve patient safety and clinical care.”
Anthem’s first phase of the initiative will preclude reimbursement to providers who have performed any of 11 preventable adverse events selected by Anthem from the broader list developed by CMS and the National Quality Forum. The list of preventable events that, if performed erroneously on Anthem members, will not be reimbursed will be expanded in the future. Anthem recently communicated to its network hospitals that its policy is intended to ensure that no one will be charged if any of the following three events occur:
— Surgery performed on the wrong body part;
— Surgery performed on the wrong patient; and
— Wrong surgery performed on a patient.
In addition, Anthem’s changes will help ensure that only the appropriate payment is made and no additional charges are incurred if any of these events occur:
— Object left in the body during surgery;
— Air embolism or blockage;
— Blood incompatibility;
— Catheter-associated urinary tract infection;
— Decubitus (pressure) ulcers;
— Vascular catheter-associated infection;
— Mediastinitis (an infection inside the chest) after coronary artery
bypass graft (CABG) surgery; and
— Hospital-acquired injuries such as fractures, dislocations,
intracranial injuries, crushing injuries and burns.
“We are listening to our members, business coalitions, and our key accounts who want to know their health plan is looking out for them,” said Dr. Jaeger. “As a strong advocate for patient safety, Anthem firmly believes that putting processes in place that focus on preventing these events can have an immediate impact on health care safety and quality.”
Anthem is in the early stages of implementation. This allows the company to work alongside hospitals to address the preventability of these events as soon as possible and continue to monitor the activities related to the list of events from the federal, state and private payers, and make adjustments as necessary and appropriate.
Anthem has long been committed to promoting patient safety including:
— Inclusion of patient safety metrics in Anthem’s Member Health Index
(MHI) program, the first program in the industry to track and compare
the collective health of all health plan members based on 20 clinical
areas and 40 separate component measures;
— Support of the Institute for Healthcare Improvement’s (IHI) 5 Million
Lives campaign, a voluntary initiative to protect patients from five
million incidents of medical harm through December 2008; and
— Participation in Leapfrog’s patient safety survey to reduce
preventable medical mistakes and improve the quality and affordability
of health care.
“The Wisconsin Hospital Association (WHA) is pleased that Anthem Blue Cross and Blue Shield in Wisconsin is focusing on serious adverse events. WHA has a long track record in working to improve quality and patient safety, and we firmly believe that it is these improvement efforts that will lead to the elimination of serious adverse events,” said Steve Brenton, President and CEO of the Wisconsin Hospital Association. “We look forward to collaborating with Anthem in this important effort.”
In Wisconsin, Anthem Blue Cross and Blue Shield is the trade name used by Blue Cross Blue Shield of Wisconsin (“BCBSWi”) and Compcare Health Services Insurance Corporation (“Compcare”), independent licensees of the Blue Cross and Blue Shield Association. (R)ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Wisconsin is available at www.anthem.com.
First Call Analyst:
Source: Anthem Blue Cross and Blue Shield in Wisconsin
CONTACT: Jill Becher of Anthem Blue Cross and Blue Shield in Wisconsin,
Web site: http://www.anthem.com/