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Monday, March 1, 2010

Blue Cross Blue Shield's new policy on never events

Certain medical errors are so horrific that they should never occur: the wrong patient having surgery, or a blood transfusion of a mismatched type, as Tawnya Brown fatally received, for example.

These cases are tragic. Adding insult to injury, the billing system of the hospital or medical practice typically bills for the treatment, and is paid for the error. The national Blue Cross Blue Shield Association has just announced
that its 39 BCBS companies have followed Medicare’s lead and adopted a formal policy not to pay for certain “never” events:

"Wrong surgeries" (wrong patient, wrong body part or wrong procedure);

Pressure ulcers stages III & IV;

Catheter-associated urinary tract infections;

Vascular catheter-associated infection;

Surgical site infection, mediastinitis, following coronary artery bypass graft (CABG);

Air embolism;

Blood incompatibility;

Foreign object retained after surgery;

Falls and trauma (fracture, dislocation, intracranial injury, crushing injury, burn, electric shock);

Surgical-site infections following certain orthopedic procedures;

Surgical-site infections following bariatric surgery for obesity;

Manifestations of poor glycemic control; and

Deep vein thrombosis and pulmonary embolism following certain orthopedic procedures.

Advice to patient advocates: Forward this to your colleagues.

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