Minnesota insurer won't pay hospitals for "never events"

A large insurer in Minnesota says it will withhold reimbursements from hospitals if certain rare, egregious errors are committed during medical procedures.

Minneapolis-based HealthPartners said in October that starting in 2005 it will refuse to pay for claims that involve any of 27 "serious reportable events," known less formally as "never events," designated in 2002 by the National Quality Forum, a health care coalition.

Payment will be refused only to hospitals in such cases. Professional fees for doctors will continue to be reimbursed, HealthPartners said.

The 27 events include surgery on the wrong body part; surgery performed on the wrong patient; incorrect surgery performed on a patient; retention of a foreign object inside a patient after surgery; and death during or immediately after surgery on a normal, healthy patient.

George Isham, MD, medical director of HealthPartners, called such mistakes "very serious and rare and unfortunate" but said there's no reason why a patient or the insurance company should have to pay for care in which they've taken place. About 40 of these events were reported by Minnesota hospitals during the first nine months of 2004, he said.

Under Minnesota's Adverse Health Care Events Reporting Law, major errors committed in hospitals have been reported to the Minnesota Hospital Assn. since July 2003. In December, the state health department will take over the error registry, and adverse events will be reported to it.

HealthPartners is asking hospitals to report these events to the health plan directly, in addition to any government notification, within 10 days of the occurrence.

The Minnesota Medical Assn. is studying the upcoming policy and hasn't yet taken a position on it, said J. Michael Gonzalez-Campoy, MD, PhD, the association's president, and an endocrinologist in St. Paul. "I can tell you, as an individual, that I don't think a lack of payment is going to prevent mistakes," he said. "I don't think it's the right approach."

The question of who would ultimately have to pay is probably a moot one, he added. "I don't think, if a very egregious mistake was made, the physician or hospital would be going after the patient for payment for those services."

The Minnesota Hospital Assn. criticized HealthPartners' move as a marketing strategy that might undercut strides various groups have made in getting medical errors reported.