BOSTON – Following Medicare’s example, but taking it up a notch, the Patrick administration last week announced that four state agencies that collectively insure or buy health care for more than 1.6 million people in Massachusetts will no longer pay for costs associated with 28 “serious reportable health care events” or allow providers to bill members for them.
The new policy makes the Bay State the first in the nation to establish a uniform non-payment policy across state government. It was developed and adopted by the Mass. Office of Medicaid (MassHealth); the Mass. Group Insurance Commission, which handles state employees’ coverage; the Commonwealth Health Insurance Connector Authority; and the Mass. Department of Correction, all of which are signatories to the state’s HealthyMass initiative.
Through HealthyMass, the agencies will work collaboratively with an advisory group that will include hospitals, the physician community, health insurance plans, and consumer representatives to implement the policy. The agencies will next explore the alignment of payment policies for preventable complications, such as hospital-acquired infections and preventable readmissions. The new policy will be implemented in each agency’s next contract cycle, state officials said.
“The alignment of payment policies on serious reportable events was identified as an early priority of HealthyMass and reflects the Commonwealth’s commitment to maximizing quality of care,” state Secretary of Health and Human Services Dr. JudyAnn Bigby, who chairs the HealthyMass Executive Committee, said Wednesday in announcing the no-pay policy. “By adopting a consistent policy, Massachusetts is applying the state’s purchasing power in support of patient safety.”
The non-payment policy will apply to the 28 serious reportable events identified by the National Quality Forum, a nonprofit coalition of physicians, hospitals, businesses and policymakers, that are considered generally preventable and of serious concern. They include surgery on the wrong body part; surgery on the wrong patient; care ordered by or provided by someone impersonating a physician, nurse, pharmacist or other licensed provider; patient death or serious disability associated with a medication or device error; non-medical but serious mistakes such as discharging an infant to the wrong parent; patient elopements, suicides or attempted suicides; and criminal acts such as sexual assault, battery or abduction.
Recent policy changes by the U.S. Centers for Medicare and Medicaid Services have also defined so-called “never events,” for which providers are fully financially responsible. But the CMS list is much narrower and applies only to hospitals, not to individual doctors.
The Massachusetts list, by contrast, will cover a wide range of providers, including chiropractors – who will be fully responsible for costs associated with damage from spinal manipulation procedures – and fertility doctors who inseminate patients with the wrong sperm.
“This new policy asserts a very important purchasing principle — that state purchasers will not pay for egregious medical errors,” said state Medicaid Director Tom Dehner, who co-chaired the HealthyMass task force on serious reportable events, in the news release. “Massachusetts is now the first state in the country to establish this kind of uniform payment policy across state government agencies, and this announcement reflects the Commonwealth’s commitment to collaboration in order to strengthen health care quality.”
Blue Cross & Blue Shield of Massachusetts issued a statement saying it “applauds” the new policy, which the insurer said is “consistent with BCBSMA’s own efforts to improve the quality, safety, and effectiveness of the health care system.”
Cleve Killingsworth, chairman and CEO of BCBSMA, said the insurer also intends to stop reimbursing hospitals for costs related to the 28 preventable medical errors included in the new state policy; the insurer also noted, however, that many Massachusetts hospitals have voluntarily stopped charging patients and insurers for some of those costs.
Lynn Nicholas, president and CEO of the Massachusetts Hospital Association, also expressed support for the policy, saying that the MHA shares the “Commonwealth’s view that serious reportable events – while extremely rare – are of concern to the public, and that every step possible must be taken to avoid them.
“Massachusetts hospitals have assumed a leadership role in adopting a voluntary practice not to charge for certain serious reportable events, and we look forward to our continued partnership with the Patrick administration in moving forward together in implementing an equitable non-payment practice for the full list of 28 events,” Nicholas said.
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Additional information, including the full list of 28 “serious reportable events” for which the state will no longer pay, is available from the Mass. Executive Office of Health and Human Services at www.mass.gov.
