NEW YORK, April 2, 2008 /PRNewswire/ -- Empire Blue Cross Blue Shield (Empire) announced today that collaborative efforts are currently underway with its hospital network that are aimed at helping to eliminate preventable adverse events as defined by the Centers for Medicare and Medicaid Services (CMS) and the National Quality Forum. In a letter released in March, as well as conversations that have occurred throughout this year, Empire has expressed its philosophy that while there are inherent risks in the delivery of health care, the occurrence of preventable adverse events should be tracked, reduced and ultimately eliminated, and that Empire customers and members should not be obligated to pay for services related to certain clearly preventable adverse events. Working with our providers on these initiatives will help protect Empire's more than five million members from both the care and cost impact of these avoidable events.
"As we work to finalize and implement our supporting policy and process surrounding adverse events, we will seek input from the New York hospital community in our efforts to align the interests and incentives of all concerned parties," said John Whitney, M.D., regional vice president, Medical Affairs and Pharmacy for Empire. "We will continue to work collaboratively with physicians and hospitals to analyze why and how these events occur, and to proactively find ways to improve patient safety and clinical care."
Empire's first phase of the initiative includes a request that
hospitals not bill, or otherwise seek reimbursement from any party, if any
of the following three adverse events occur:
-- Surgery performed on the wrong body part;
-- Surgery performed on the wrong patient; and
-- Wrong surgical procedure performed on a patient.
Empire will also work collaboratively with its participating hospitals
and physicians to ensure that only the appropriate payment is made, and its
customers and members incur no additional costs, associated with the
occurrence of any of these adverse events or hospital acquired conditions
-- Object left in the body during surgery;
-- Air embolism or blockage;
-- Blood incompatibility;
-- Catheter-associated urinary tract infection;
-- Decubitus (pressure) ulcers;
-- Vascular catheter-associated infection;
-- Mediastinitis (an infection inside the chest) after coronary artery
bypass graft (CABG) surgery; and
-- Hospital-acquired injuries such as fractures, dislocations,
intracranial injuries, crushing injuries and burns.
"This is an opportunity for us to work together with the New York hospital community to proactively address commercial reimbursement for major preventable adverse events in a way that communicates to employers and members our joint commitment to eliminate these occurrences," said Dr. Whitney. "As a strong advocate for patient safety, Empire firmly believes that putting processes in place that focus on preventing these events can have an immediate impact on health care safety and quality."
Empire is in the early stages of implementation. This allows the
company to work alongside hospitals to address the preventability of these
events as soon as possible and continue to monitor the activities related
to the list of events from the federal, state and private payers, and make
adjustments as necessary and appropriate.
Empire has long been committed to promoting patient safety including:
-- Inclusion of patient safety metrics in Empire's quality programs as
well as the Member Health Index (MHI) program, the first program in the
industry to track and compare the collective health of health plan
members based on 20 clinical areas and 40 separate component measures;
-- Support of the Institute for Healthcare Improvement's (IHI) 5 Million
Lives campaign, a voluntary initiative to protect patients from five
million incidents of medical harm through December 2008; and
-- Participation in Leapfrog's patient safety survey to help reduce
preventable medical mistakes and improve the quality and affordability
of health care.
"Empire's efforts to concentrate on patient safety and work toward eliminating avoidable hospital errors are commendable and commensurate with our goals for a safer health care system that must realign itself to pay on the basis of safety and quality," said Diane Pinakiewicz, president of the National Patient Safety Foundation. "It is important that our industry find ways to correct the systems issues that allow avoidable errors to occur, and Empire's leadership in the field will help move us in this direction."
About Empire Blue Cross Blue Shield
Empire Blue Cross Blue Shield (Empire) is the trade name of Empire HealthChoice Assurance, Inc., and Empire Blue Cross Blue Shield HMO is the trade name of Empire HealthChoice HMO, Inc., independent licensees of the Blue Cross Blue Shield Association, serving residents and businesses in the 28 eastern and southeastern counties of New York State. Additional information about Empire is available at http://www.empireblue.com
|SOURCE Empire Blue Cross Blue Shield|
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