Legal trend? No charge for adverse events

Legislation passed in Massachusetts, Minnesota

It's bad enough when a patient suffers an adverse event from a wrong-site surgery or a medication error; it only adds insult to injury when the patient or his insurer is billed for the procedure in which the error occurred. Hospitals in Minnesota and Massachusetts have become the first in the country to adopt policies that say patients harmed by certain adverse events won't be charged for them.

Minnesota announced in September that patients at hospitals in that state won't be billed should they experience any of 27 specified adverse health events. The 116 hospitals and health systems belonging to the Massachusetts Hospital Association followed in November with the announcement that they have adopted a uniform policy to not charge for nine adverse events as defined by the National Quality Forum. (See table, below, for events the two states won't bill for.)

It's a growing trend being adopted at various levels across the country, often starting at the single-hospital level. But Medicare is putting some teeth into the push for greater provider accountability for preventable errors. Medicare announced earlier in 2007 that, starting in October 2008, it will no longer pay hospitals for care resulting from eight complications, including falls, foreign objects left inside patients after surgery, bedsores, and three types of hospital-acquired infections.

"This represents a major step forward and builds on several groundbreaking transparency and quality initiatives that have put us ahead of the curve nationally," says Lynn Nicholas, FACHE, president and CEO of the Massachusetts Hospital Association. "This policy sends a strong message to patients that their hospital is committed to doing everything possible to eliminate these types of events."

In both Minnesota and Massachusetts, the newly adopted policies codify what many in those states already were doing. In addition, both states have adopted processes of disclosure and apology following adverse events, and hospitals in both states report adverse events to public health authorities.

"Obviously, the ultimate goal is to reduce these errors," Nicholas says. "But as human error is inevitable, we'll attempt to learn from our mistakes, acknowledge the profound effect they have on patients, and ultimately expand the list of serious adverse events that should not occur and for which hospitals should not charge."


For more information, contact:

  • Massachusetts Hospital Association, 101 Arch Street, Suite 1741, Boston, MA 02109. Phone: (617) 367-9667.
  • Minnesota Department of Health, Division of Health Policy. P.O. Box 64975, St. Paul, MN 55164. Phone: (651) 201-3564.
  • Minnesota Hospital Association, 550 University Ave. W., Suite 350-S, St. Paul, MN 55114. Web: