Patrick Administration Announces Non-Payment Policy for 28 Serious Reportable Events

News / Patrick Administration Announces Non-Payment Policy for 28 Serious Reportable Events

BOSTON — Representatives from across state government, in their roles as health insurance purchasers and signatories to the Commonwealth’s HealthyMass initiative, today announced their intentions to no longer pay for costs associated with certain serious reportable health care events. The state will also no longer permit their providers to bill members for these services. This new policy makes Massachusetts the first state in the nation to establish a uniform non-payment policy across state government.

“The alignment of payment policies on serious reportable events was identified as an early priorityof HealthyMass and reflects the Commonwealth’s commitment to maximizing quality of care,” said Secretary of Health and Human Services Dr. JudyAnn Bigby, who chairs the HealthyMass Executive Committee. “By adopting a consistent policy, Massachusetts is applying the state’s purchasing power in support of patient safety.”

The new policy was developed and adopted by four state agencies: the Office of Medicaid (MassHealth); Group Insurance Commission; Commonwealth Health Insurance Connector Authority; and Department of Correction. Collectively, they insure or purchase care for more than 1.6 million people in Massachusetts. These entities recognize that a uniform policy will establish incentives for providers to improve the quality and effectiveness of patient care. 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 state agency’s next contract cycle.

The non-payment policy will apply to the 28 serious reportable events identified by the National Quality Forum, a non-profit coalition of physicians, hospitals, businesses and policy-makers. These incidents are generally preventable and present serious concerns for consumers and health care providers. 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; and patient death or serious disability associated with a medication error. A list of all 28 serious reportable events for which the state will no longer pay is attached.

"This new policy asserts a very important purchasing principle — that state purchasers will not pay for egregious medical errors," said Medicaid Director Tom Dehner, who co-chaired the HealthyMass task force on serious reportable events. "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."

Dolores Mitchell, Executive Director of the Group Insurance Commission and co-chair of the HealthyMass serious reportable events task force, added, “The Group Insurance Commission is pleased to join with its colleagues in state government in this important initiative, which puts the agencies of the Commonwealth solidly behind efforts to improve patient safety. The policy we are announcing today is not just about saving money. Its real goal is to focus attention on preventable errors in our health care system and to make sure that appropriate changes are implemented so that they don’t happen again.”

“The 'never events' policy that the Patrick Administration is adopting shows a dedication to perfecting and understanding the needs and benefits of a comprehensive health care system in the Commonwealth,” said Senator Richard T. Moore, Senate Chair of the Committee on Health Care Financing. “The citizens of Massachusetts will certainly benefit from its implementation. Individuals will not have to worry about health care costs that are unnecessary, after improper treatment is administered." Moore is the patient safety movement’s strongest advocate in the Senate and is widely recognized as a leader on the issue.

Lynn Nicholas, President and CEO of the Massachusetts Hospital Association, added, “We share 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.”

This new policy builds on state efforts already underway through the Department of Public Health (DPH) and the Health Care Quality and Cost Council. DPH requires hospitals to report serious incidents to the agency and recently expanded its list of serious incidents to include all 28 serious adverse events. Hospitals must now not only report a serious incident, but also identify whether it classifies as a NQF-defined adverse event. Based on recommendations from the Quality and Cost Council, DPH will begin publicly reporting serious reportable events at individual hospitals this fall.

In addition, DPH will continue to partner with and provide funding for the Massachusetts Coalition for the Prevention of Medical Errors to assist hospitals in reducing the occurrence of serious reportable events. The Coalition has extensive experience in developing tools and methods for engaging hospitals in collaborative learning sessions that enable participants to share best practices.

The HealthyMass initiative includes five taskforces that meet regularly to develop and implement comprehensive plans, policies, and programs to achieve short- and long-term goals in the areas of Serious Reportable Events; Performance Measurement Alignment; Payment System Reform; Disease Management and Wellness; and Administrative Simplification.
About the HealthyMass Initiative

In December 2007, leaders from across state government came together—in their roles as purchasers; providers; regulators; insurers; stewards of public health; and potential sources for health care financing— to launch HealthyMass, a cross-agency initiative to build on health care reform. Collaborative efforts focus on five key areas: ensuring access to care; containing health care costs; advancing health care quality; promoting individual wellness; and developing healthy communities. The nine participating agencies are: the Executive Office of Health and Human Services; Executive Office of Administration and Finance; Office of the Attorney General; Commonwealth Health Insurance Connector Authority; Division of Insurance; Group Insurance Commission; Massachusetts Health and Educational Facilities Authority; Massachusetts Development Finance Agency; and Department of Correction.
Complete List of 28 Serious Reportable Events
Surgical Events

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Surgery performed on the wrong body part
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Surgery performed on the wrong patient
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Wrong surgical procedure performed on a patient
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Unintended retention of a foreign object in a patient after surgery or other procedure
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Intraoperative or immediately post-operative death in an ASA Class 1 patient

Product or Device Events

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Patient death or serious disability associated with the use of contaminated drugs, devices, or biologics provided by the healthcare facility
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Patient death or serious disability associated with the use or function of a device in patient care, in which the device is used or functions other than as intended
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Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a healthcare facility

Patient Protection Events

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Infant discharged to the wrong person
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Patient death or serious disability associated with patient elopement (disappearance)
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Patient suicide, or attempted suicide resulting in serious disability, while being cared for in a healthcare facility

Care Management Events

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Patient death or serious disability associated with a medication error (e.g., errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation, or wrong route of administration)
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Patient death or serious disability associated with a hemolytic reaction due to the administration of ABO/HLA-incompatible blood or blood products
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Maternal death or serious disability associated with labor or delivery in a low-risk pregnancy while being cared for in a healthcare facility
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Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility
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Death or serious disability associated with failure to identify and treat hyperbilirubinemia in neonates
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Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility
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Patient death or serious disability due to spinal manipulative therapy
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Artificial insemination with the wrong donor sperm or wrong egg

Environmental Events

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Patient death or serious disability associated with an electric shock or elective cardioversion while being cared for in a healthcare facility
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Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances
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Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility
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Patient death or serious disability associated with a fall while being cared for in a healthcare facility
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Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility

Criminal Events

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Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider
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Abduction of a patient of any age
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Sexual assault on a patient within or on the grounds of the healthcare facility
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Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of the healthcare facility

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