From One Mother to Another

 

More for patients to worry about ...

According to a press release issued last week by CIGNA HealthCare, the insurance giant will stop reimbursing hospitals for so-called “never events” and other avoidable hospital conditions that are noted as errors in patient care. These “never events” would encircle something along the lines of a foreign object (like a surgical sponge, for example) being left inside a patient following a surgical procedure.

Anyone who has been keeping up with CMS’ (the Centers for Medicare & Medicaid Services) lead to do this — citing such reasons as “patient safety” and “improving healthcare quality” — knew it was only a matter of time before all of the major managed care organizations would follow suit. Both CIGNA’s policy and CMS’ will become effective on Oct. 1.

So who will pay for these never events?

The intention here is to “punish” — if you will — the healthcare facility owner for its error. Is this actually what will happen? Or will the hospitals eventually begin coming after the patients for this cost? I suspect the later.

Or, perhaps the taxpayer will eventually be the one to take the hit? Or wait. Isn’t the taxpayer already paying for it and that’s why CMS says no more?

When you are able to shake that confusion away, you can check out CIGNA’s note on the topic in this press release: “CIGNA's policy is designed to avoid member liability for any payment denials to participating facilities.”

But I still feel woozy about this. Not that I don’t buy that CIGNA really is attempting to look out for its members, I just mean that things like this have to get absorbed somewhere. And that sponge doesn’t often get absorbed by the abdominal wall.

Good intentions or not, the pessimist in me screams “watch out!” What’s your take on the matter?