The trade group for California health insurers is supporting the prohibition on reimbursing providers for so-called never events. The board of the California Association of Health Plans unanimously passed a resolution in favor of no longer paying for the CMS list of eight never events as well as three other preventable mistakes. These medical errors include objects left in a patient's body during surgery, air embolisms, hospital-acquired infections and injuries and wrong-site or wrong-patient surgeries.
The association said it also supports a bill moving through the California Legislature that would prohibit providers from billing payers for adverse events that cause the death or injury of patients. We want to be sensitive to making sure we are not only doing the right thing clinically but that our administrative policies are fair to all involved, said Christopher Ohman, president and chief executive officer of the association.
The association has not yet decided whether it will support banning payment for other adverse events identified by the CMS and National Quality Forum, such as delirium. That may not meet our test, Ohman said. How do you know something wasn't present on admission?
The associations board is made up of healthcare executives from Aetna, Anthem Blue Cross and Blue Shield, Cigna Corp., Health Net, Kaiser Permanente, UnitedHealth Group and other insurers. The association represents 40 public and private health plans that provide coverage to more than 21 million Californians. (Also see today's Reporter's Notebook item below.)-- by Rebecca Vesely