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No payment for events deemed avoidable

Posted Oct 05 2009 10:03pm

In the push to force “medicine” to reduce or eliminate errors Medicare, some private insurance companies and many states are creating lists of events for which payment will not be made.   The lists of events for which payment will be denied varies between payers.   Here is the list recently published by the State of New York for Medicaid payments:

  1. Surgery performed on the wrong body part;   
  2. Surgery performed on the wrong patient;   
  3. Wrong surgical procedure on a patient;   
  4. Foreign object inadvertently left in patient after  surgery;   
  5. Medication error;   
  6. Air embolism;   
  7. Blood incompatibility;   
  8. Patient disability from electric shock;   
  9. Patient disability from use of contaminated drugs;   
  10. Patient disability from wrong function of a device;   
  11. Incidents whereby a line designated for oxygen  intended for patient is wrong item or contaminated;   
  12. Patient disability from burns;   
  13. Patient disability from use of restraints or  bedrails; and   
  14. Patient disability from failure to identify and treat hyperbilirubinemia (bilirubin in blood) in newborns.

David S. Smith, M.D., Ph.D.

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