CFOSnafu.com » Sure-fire way to lower medical bills (may require injury)

Sure-fire way to lower medical bills (may require injury)

May 8, 2008 by Shane Borer
Posted in: In this week's e-newsletter, Insurance, Latest news & views

A true sign that all isn’t well in the healthcare industry: It’s actually cheaper for both employers and employees when a doctor makes a major mistake.

Never thought you’d see the day when you actually wanted a slip-up to happen in a hospital? Benefits company WellPoint, Inc. is changing its provider reimbursement practices to withhold payment for certain medical errors, called “never events” (more on that later).

So, if a doctor performs surgery on the wrong body part or patient, performs the wrong surgery on a patient — basically, if something goes wrong that shouldn’t — the hospital won’t be able to collect payment from WellPoint.

It’s not just covering it’s own skin, though. WellPoint’s strategy will also save patients and their employers money by preventing in-network hospitals from billing them directly for the work.

Dr. Sam Nussbaum, WellPoint’s VP for Clinical Health Policy and Chief Medical Officer says the company believes in “putting processes in place that focus on preventing these events since they can have an immediate impact on healthcare safety and quality.”

Oh, and those so-called “never events” the company’ll be protecting people against? Here’s the breakdown:

  1. Surgical errors
  2. Product or device events, like using contaminated drugs or anesthetics,
  3. Care management events, such as medication errors,
  4. Environmental events, like electrical shocks, burns, etc.,
  5. Criminal events, like the sexual assault of a patient, and
  6. Patient protection events, such as discharging an infant to the wrong person.

We want to be a fly on the wall during that collections call: “Sorry we misplaced your baby; that’ll be $13,000, please.”

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