HealthPartners, one of Minnesota's biggest health plans, says starting Jan. 1 it will no longer cover certain medical procedures if they go wrong. For example, HealthPartners said, it will no longer cover a surgery if an operation is performed on the wrong body part or on the wrong patient, or if a foreign object is left inside a patient.
"It's about accountability," said George Isham, M.D., medical director for HealthPartners, based in Minneapolis. "We're sending the message that things that shouldn't happen shouldn't be paid for."
It's the first effort in Minnesota to penalize health providers for bad care. The Minnesota Hospital Association, the Minnesota Council of Health Plans and other healthcare officials said they haven't heard of a similar policy elsewhere.
These types of mistakes are rare, so the cost savings won't add up to much, HealthPartners said.
HealthPartners provides health coverage to 630,000 members and has a network of physicians and hospitals, including HealthPartners Clinics. It's the state's third biggest health insurer, after Blue Cross and Blue Shield of Minnesota and Medica.
As healthcare costs have spiraled, health plans and employers have stepped up efforts to get providers to follow so-called "best practices" to lead to optimal care. So far, these efforts have focused on rewarding physicians and hospitals for meeting certain targets.
In addition, health plans nationwide have had incentive plans for several years. HealthPartners introduced its first program in 1997 and this year expects to pay up to $16 million in bonuses to physicians and hospitals.
The decision to stop paying for adverse events takes the philosophy a step further.
The idea stems from a 1999 report from the National Academies' Institute of Medicine which estimated that between 44,000 and 98,000 people die in any given year from medical errors in U.S. hospitals.
The report led the National Quality Forum -- a coalition of hospitals, health plans, employers and government -- to compile a list of 27 adverse events called "never" events. The events cover surgery, products and devices, patient protection (such as an infant being discharged to the wrong person) and patient care (such as patient death due to medication error).
Since July 2003, providers in Minnesota have been required to report adverse events. The Minnesota Department of Health will take over the list Dec. 6 and will publish the first year's worth of data in early 2005, listing events by type and facility.
The report will include data collected from 138 hospitals, some 30 outpatient surgical centers and several regional treatment centers.
"There are not a lot of events and not huge amounts of trending data," said Marie Dotseth, senior policy adviser for patient safety at the Department of Health.
Isham said there were a total of 40 events spread over 15 hospitals that contract with HealthPartners in the first 10 months of reporting.
Fourteen incidents were related to care management and 18 to surgical procedures. Of the surgical events, 10 involved surgery on the wrong site, the wrong surgical procedure, or surgery on the wrong patient. Only a portion of the 40 events involved HealthPartners patients, he said.
Starting Jan. 1, hospitals that contract with HealthPartners will be required to tell HealthPartners within 10 days of discovering an adverse event.
Since billing cycles range from weeks to months, that will allow HealthPartners to identify the procedures and patients for which it won't pay.
Blue Cross and Medica officials said they don't have immediate plans to follow in HealthPartners' footsteps.