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Health insurers join push to end 'never events'


By Troyen Brennan, M.D., and Don Liss, M.D.
Posted: April 21, 2008 - 12:01 am ET
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Making healthcare safer is one area where there is vigorous agreement among all constituents—it is critical to improving the quality of life for patients and should reduce medical costs. The good news is that there are established ways to achieve this goal. Each of us in the healthcare system has a role to play through individual actions and, more importantly, by working together.

As examples, in recent years we’ve seen medical industry and pharmaceutical experts collaborating to make prescription bottle labels more understandable to consumers. A retail store has taken the initiative to develop its own easier-to-read prescription bottle. Design guidelines specifying more uniform and visible controls on anesthesia machines have been established. And, of course, hospitals have demonstrated dramatic improvements in preventing poor outcomes and untoward events.

Insurers also have a role to play in improving safety. Access to a broad array of data on the member’s health enables us to signal to providers and our members about potential gaps in care by leveraging technology, especially through the member’s personal health record. But we also contribute by creating incentives as part of the way we pay for care. As a member of the Leapfrog Group, Aetna is encouraging hospitals to adopt those processes proven to reduce errors, to establish a culture that makes patient safety fundamental to the operation of the facility and to report “never events” identified by the National Quality Forum. We support public recognition for hospitals that voluntarily develop procedures around reporting these events. Further, Aetna has established models for paying hospitals based on their adherence to processes proven to reduce adverse events and promote patient safety. We make information about patient-safety outcomes available online to our members and encourage them to consider this information when they seek care.

Recently we announced our next step—the development of “never events” language, based on the NQF list, for our hospital contracts. When we negotiate a new hospital agreement or renegotiate an agreement with a hospital already in our network, we will seek to add this provision. The NQF list is clinically credible and has been vetted through a rigorous review process by multiple healthcare stakeholders.

The language in our contracts calls for hospitals to report the medical error to at least one of the following agencies within 10 days of becoming aware it has occurred: the Joint Commission, state reporting programs for medical errors or patient-safety organizations. Hospitals also are asked to take action to prevent future events, waive all costs related to a serious reportable event, and apologize to the patient and/or family affected by the event.

While the professional commitment of highly skilled hospital staff and physicians is clearly the most fundamental force promoting patient safety and improvements in care, an unambiguous and real contract provision can only serve to reinforce hospitals’ focus on reporting medical errors, consistent with our belief that shared information and transparency are keys to better care.

And we aren’t alone. More than 600 hospitals already have demonstrated leadership by voluntarily agreeing to report never events. Minnesota and other states use all or portions of the NQF-endorsed list of events as the foundation of their state-based public reporting system.

The CMS has taken a further step, moving from the NQF list of never events—all of which are clearly errors that should never occur—to refusing to pay for common iatrogenic injuries that are, in some cases, preventable. We are not persuaded that this broader approach will have the same effect on encouraging a culture of safety that the focus on never events does.

No one wants medical errors to happen. We believe it is time for a cultural shift in how safety issues are approached in our healthcare system. Performance measurement, public reporting and financial incentives are some of the levers that can promote this shift. We hope this strategy will lead to broader adoption of quality measures and reporting, and encourage others in healthcare to support this effort.

Troyen Brennan, M.D., is Aetna's chief medical officer. Don Liss, M.D., is Aetna's regional medical director, mid-Atlantic region.

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