MA hospitals adopt error-related bill policy

In early 2008, Massachusetts hospitals will adopt a uniform policy not to charge patients or insurers for certain rare but serious adverse events, the Massachusetts Hospital Association announced recently.

The policy initially will cover nine preventable events from the National Quality Forum's list of serious reportable events and be expanded with experience, MHA said.

The events are surgery on a wrong body part or patient, wrong surgical procedure, retention of foreign object, medication error injury, incompatible blood-associated injury, air embolism-associated injury, artificial insemination/wrong donor, and infant discharged to wrong family.

Many hospitals already follow such a policy, the organization notes. Minnesota hospitals announced a similar statewide policy in September 2007.

Uncompensated care up $2.4 billion in 2006

The cost of uncompensated care in the United States totaled $31.2 billion in 2006, up from $28.8 billion in 2005 and $21.6 billion in 2000, according to the latest data from the American Hospital Association's Annual Survey of Hospitals.

Underpayment by Medicare and Medicaid reached nearly $30 billion in 2006, up from $25.3 billion in 2005 and $4 billion in 2000. Medicare reimbursed 91 cents and Medicaid reimbursed 86 cents for every dollar hospitals spent caring for these patients.

The data are summarized in two AHA fact sheets, available online at

On-call coverage gap hurts hospitals, patients

Physician specialists are increasingly reluctant to provide emergency on-call coverage at hospitals, which results in higher costs for hospitals and reduced access to specialist care for patients, according to a study in 12 communities by the Center for Studying Health System Change.

Many specialists are shifting their services to non-hospital settings or specialty hospitals, believe payment for emergency care is inadequate, have medical liability concerns with ED coverage, or view it as a burden, the authors said.

To deal with the problem, hospitals are paying for on-call coverage, physicians' malpractice premiums and treatment of uninsured patients while on call, directly employing specialist physicians, and pursuing other administrative arrangements to encourage physicians to take ED call, the study found.

Smaller jump expected in health benefits costs

Employer costs for health benefits rose 6.1% in 2007 to an average of $7,983 per employee, according to a national survey by benefit consultant Mercer.

Employers expect a smaller increase of 5.7% in 2008 after anticipated changes in plans and benefits, the survey found.

Mercer attributes smaller increases in employer costs since the early 2000s in part to increased cost shifting to employees. For example, average in-network deductibles for Preferred Provider Organizations rose about 11% in 2007 among larger employers (those with 500 or more workers), Mercer said. About 80% of large employers used health management programs as another way to control costs.

The share of employers with fewer than 200 workers offering health coverage continued to decline, to 61% in 2007 from 63% in 2006. The share of all employees enrolled in a health savings account or health reimbursement account rose to 5% from 3%. Most of the newer plans were HSAs, which don't require an employer contribution.