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April 11 - WellPoint to Stop Paying for Treatment of Preventable Hospital Errors, Injuries

WellPoint, Inc., a health benefits company, has announced systemwide process changes for its national provider network to be implemented this year. The changes will include reimbursement modifications and are aimed at eliminating preventable adverse events as defined by the Centers for Medicare & Medicaid Services and the National Quality Forum. They will help protect WellPoint’s 35 million members from additional payments resulting from these errors.

WellPoint’s first phase of this initiative includes 11 preventable adverse events and will be modified and expanded in the future. The company recently communicated to its network hospitals about its policy intended to ensure that no one will be charged if any of the following three events occur:
• surgery performed on the wrong body part;
• surgery performed on the wrong patient; and
• wrong surgery performed on a patient.

In addition, WellPoint’s changes will help ensure that only the appropriate payment is made and no additional charges are incurred if any of the following events occur:
• 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 surgery; and
• hospital-acquired injuries such as fractures, dislocations, intracranial injuries, crushing injuries, and burns.

WellPoint 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 federal, state, and private payers and make adjustments as necessary and appropriate.

Source: WellPoint, Inc.

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