The insurers are emulating the federal Medicare program, which is slated in October 2008 to stop paying additional costs associated with treating bed sores, falls and six other preventable injuries and infections that occur during a patient’s hospital stay. Next year, Medicare’s nonpayment stance will include hospital-acquired blood infections, blood clots in legs and lungs, and pneumonia contracted from a ventilator.
Initially, private health insurance companies are examining nonpayment for only the worst of mistakes, but company executives say it’s only a matter of time until the industry will also refuse to pay for some of the same problems that Medicare is pinpointing. Aetna President Mark Bertolini says, “I’d rather have the cudgel in place first than push the list too far.
Some hospitals and others are concerned that the new strategy could drive up medical costs in other ways as hospitals absorb or pass on the expense of introducing the safety and screening procedures needed to help avoid mistakes.
Ultimately, insurers say, their tougher stance will result in safety improvements and savings for patients.