Corporate Compliance

CIGNA to stop paying for 'never events'

Compliance Monitor, April 30, 2008

Add health insurer CIGNA to the list of those who won’t bill or pay for preventable medical errors, known as ‘never events.’
 
Beginning October 1, CIGNA will stop reimbursing hospitals for never events and avoidable hospital conditions, according to a company press release. WellPoint and Aetna have also said they will no longer reimburse hospitals for never events.
 
According to CIGNA’s policy, never events are surgical procedures performed on the:
  • Wrong side
  • Wrong site
  • Wrong body part
  • Wrong person
An avoidable hospital condition is one a patient does not have when admitted to the hospital, develops during the patient’s hospital stay, and could have been avoided if the hospital had followed evidence-based guidelines and best practices for patient care.
 
Avoidable hospital conditions include:
  • Objects left inside a patient during surgery
  • Air embolism, or sudden artery blockage from air bubbles introduced during surgery
  • Use of the wrong blood type during transfusions
  • Infections from urinary catheters
  • Pressure ulcers
  • Infections from central vein catheters
  • Mediastinitis, an often fatal inflammation in lung tissue
  • Hospital-acquired injuries, such as fractures, dislocations, and burns
Medicare announced in August 2007 that it would stop paying for eight preventable complications and recently proposed adding nine more complications to the list. Hospitals in four states-Pennsylvania, Massachusetts, Minnesota, and Washington-have agreed not to charge for all never events, while hospitals in other states have agreed not to charge for some never events.

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