Half of hospitals don't bill for 'never events'

If you make a mistake — a really big mistake — is it fair to bill the patient or insurer for the service?

Many health care providers are formally adopting policies that state they will not bill patients or insurers for the worst type of mistakes known as "never events" because they should never happen. One example is intraoperative or immediately postoperative death in an ASA Class I patient.

The Leapfrog Group, a patient safety organization, reports that just more than half (52%) of hospitals responding to its Leapfrog Hospital Quality and Safety Survey indicate they have adopted the Leapfrog Never Events policy, a list of actions they pledge to take whenever a never event occurs. By agreeing to this policy, hospitals pledge to take these steps when a never event happens:

  • waive all costs directly related to the serious reportable adverse event;
  • apologize to the patient and/or family affected by the never event;
  • report the event to at least one of the following agencies: The Joint Commission, a state-reporting program for medical errors, or a patient safety organization;
  • perform a root-cause analysis, consistent with instructions from the chosen reporting agency.

To define never events, Leapfrog uses the National Quality Forum's (NQF) definition of "serious reportable events." (For more information, go to www.qualityforum.org/projects/completed/sre.) The NQF's list includes errors such as performing surgery on the wrong body part or on the wrong patient, and leaving a foreign object inside a patient after surgery.

Not billing for the mistake is a key part of taking responsibility and making amends, says Suzanne Delbanco, CEO of The Leapfrog Group. "The hospitals who agree to our never events policy are also helping us to pioneer ways to tie payments for care to quality," she says. In the past, health care providers have seen the issues as separate, with the bills going out automatically regardless of the quality of care, she says. An analysis of survey results seems to show that smaller hospitals have a slight edge over larger ones in the rate of adoption of the Leapfrog Never Events policy. In the survey, 59% of small hospitals (one to 100 beds) had adopted the policy, compared to 53% of medium hospitals (101-250 beds) and 48% of large hospitals (251+ beds).

Hospitals that agree to the never events policy are twice as likely to have scored full points on the Leapfrog Safe Practices Score (SPS) than those hospitals that have not adopted the policy. The SPS, which Leapfrog says is an indicator of how committed a hospital is to maintaining high levels of quality and safety, asks hospitals how well they implement 27 of the NQF's Safe Practices. Thirty-three percent of hospitals who commit to the Leapfrog never events policy have scored full points on the SPS; only 17% of those who did not commit to the policy scored full points on the SPS. (For more on the results of the Leapfrog survey, go to the Leapfrog Group's web site at www.leapfroggroup.org and select "2007 Leapfrog Top Hospitals and Survey Results" on the home page.)