Hospitals are supposed to be places where people get well. Unfortunately, hospitals are sometimes places where injuries occur. New York State’s three largest medical insurers – Empire Blue Cross Blue Shield, Oxford and HIP - now want to stop paying hospitals when preventable adverse events or malpractice occur. The insurers plan to implement language in their policies prohibiting the hospital from billing the carrier for the subsequent treatment required as a result of hospital errors

This is a move to lower the financial burden of health care insurers – who eventually pass the costs on to their insured. Lisa Greiner, a spokeswoman for Empire Blue Cross Blue Shield confirmed in a Long Island Business News article in the March 21, 2008 edition, that the insurer is working with physicians and hospitals to identify preventable adverse events. The rub comes from the definition of a “preventable adverse event”. Beginning in October 2008, Medicare will no longer reimburse hospitals for care related to eight different errors occurring during the patient’s stay. 

 Is it an attempt by insurers to help improve the quality of care at hospitals or a way to reduce their costs? The answer is probably both.  

Some of the errors Insurers have identified as preventable include:

·         Incompatible blood transfusion

·         An object left in a patient after surgery

·         Air embolisms

Many hospitals no longer bill insurers for obvious and serious preventable errors such as performing surgery on the wrong patient or the wrong body part.

If the measure by the insurance companies improves the quality of care for patients by making hospitals more diligent about error prevention, because they won’t get reimbursed for their liability by the insurance company, the measure is a good one. However, if it increases the financial burden on hospitals, it will not be good for hospitals. Doctors are increasingly leery of things that are couched in quality and safety and really amount to nothing more than cost-cutting.

If you are unfortunate enough to get injured during a hospital stay, you may be entitled to compensation for your injuries. If you would like to discuss your particular situation, call us for a free consultation – to know your rights, just in case.