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Wellpoint to stop paying for 11 medical errors

Quality Improvement Monitor, April 4, 2008

Following the government's lead, Wellpoint, one of the nation's largest healthcare insurers, announced this week it will no longer pay for 11 medical errors it considers preventable, according to the Indianapolis Star.

"We know there are a number of events that happen for hospitalized patients that are absolutely preventable," Sam Nussbaum, MD, WellPoint's executive vice president for clinical health policy and chief medical officer, told the paper. "These are errors that really relate to the process of care."

Wellpoint, which will begin its new policy later this year, will no longer reimburse hospitals which operate on the wrong body part, the wrong patient, or perform the wrong surgery . The insurer will also stop paying for additional costs associated with the eight mistakes CMS will no longer reimburse hospitals for beginning October 1, 2008 unless they were documented as present on admission. They include:

  • Serious preventable event -- object left in surgery
  • Serious preventable event -- air embolism
  • Serious preventable event -- blood incompatibility
  • Catheter-associated urinary tract infections
  • Pressure ulcers
  • Vascular catheter-associated infection
  • Surgical site infection -- mediastinitis after coronary artery bypass graft surgery
  • Patient falls

    Other insurers may follow the federal agency's new policy, the Star said "We continue to evaluate the new Medicare policies and how they may be applied to best meet the needs of our members," Debora Spano, spokeswoman for UnitedHealthcare, told the paper.

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