Five State Agencies Adopt Uniform Non-Payment Policy for Medical Errors

BOSTON — The Patrick-Murray Administration announced today that five state agencies have adopted uniform non-payment policies for costs associated with 28 serious reportable health care events, with the goal of advancing quality care for residents of the Commonwealth as part of the HealthyMass initiative. The state’s Office of Medicaid, Health Safety Net, Commonwealth Connector, Group Insurance Commission and Department of Correction have adopted a single set of guidelines to reduce preventable medical errors and advance patient safety. Collectively, these five agencies insure or purchase care for more than 1.6 million people in Massachusetts.

This new policy makes Massachusetts the first state in the nation to establish a uniform non-payment policy across state government. Under the new guidelines, which are effective immediately, state agencies and their contractors will not pay for certain serious reportable health care events, as defined by the National Quality Forum, a non-profit coalition of physicians, hospitals, businesses and policy-makers. These largely preventable events 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.

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

Hospitals, ambulatory surgery centers and physicians are all subject to the non-payment policy and will be prohibited from charging or seeking reimbursement for services that are directly related to the occurrence of the event; any correction or remediation needed; or care associated with complications arising from the occurrence of the event. Providers that accept transferred patients who were previously injured by a serious reportable event at another institution or under the care of another physician may bill and receive payment for services provided.

In addition, health care providers will not be permitted to bill members, his or her next of kin, or any other payer for costs associated with these events and must waive any copayment or deductible from the patient for the admission during which the event occurred. Members of the HealthyMass task force on serious reportable events will continue to work closely with providers, insurance plans and consumers to implement these new guidelines. When implementing these new guidelines, payers and providers are encouraged to use existing procedures to minimize administrative burdens.

"The message of this new state policy is clear: state purchasers and Massachusetts tax payers 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 the first state in the country to establish this kind of uniform non-payment policy across state government, and this announcement reflects our commitment to working together 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, “These new shared guidelines reflect the Commonwealth’s commitment to improving patient safety. This is not just about saving money but about focusing attention on preventable health care errors and taking appropriate steps to make sure that they don’t happen again.”

These new state guidelines complement other ongoing state efforts by the Department of Public Health (DPH), which continues to partner with the Massachusetts Coalition for the Prevention of Medical Errors to assist hospitals in reducing the occurrence and serious reportable events. DPH also now requires that hospitals report serious incidents to the agency. DPH began publicly reporting serious reportable events at individual hospitals earlier this year. At the same time, the state’s Health Care Quality and Cost Council is developing standards for patient safety in settings other than acute care hospital.

In May, the state’s Public Health Commission approved new regulations requiring that hospitals file a report of the event with both DPH and the third-party payer within seven days. Hospitals must also notify the patient within seven days and provide information about unanticipated outcomes of care, treatment and services provided as a result of the SRE and the option of receiving a copy of the report filed with the state. If the event was preventable, within in the hospital’s control and clearly the result of a system failure, the hospital may not charge a patient or third-party payer for any services provided.

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. For more information about the HealthyMass initiative, please visit: www.mass.gov/healthymass.

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