'Never events' no more: Bolton's top priority is eliminating preventable medical errors

The ink is barely dry on our 2011 calendars, and here in Palm Beach County we're already finding ourselves in the thick of a request for proposal for our self-insured health plan for 2012.

Government entities live and die to ensure the competitive process is fairly offered to all interested vendors, and Palm Beach County's purchasing gurus are more committed than the average (in my slightly biased opinion).

With a contract's lifespan capped at around five years or so, we bear the relatively regular responsibility to shop a health plan that touches the lives of nearly 5,000 employees and their family members.

No small task. No small amount of stress. No small amount of red wine consumed by yours truly during the grueling process!

I will spend the lion's share of 2011 preparing for 2012. (See the page 1 story, "Past gazing, future facing" to see how other employers also are spending the present preparing for the future.)

The county's RFP soon will be "on the street." At the risk of publishing my heart's desires in my column, and giving those insurers who read EBN an unfair competitive advantage to use in their proposals (which could result in a hefty slap on my dainty wrist from those purchasing gurus I mentioned), I'll limit my written wish list to just one item that's been nagging away at me for some time.

I'm talking about preventable hospital-acquired conditions caused by preventable errors and safety snafus that can bloat the bottom line of the health plan and devastate the lives of its members.

These items are commonly known as "never events," a phrase coined by the good Dr. Ken Kizer in 2001 at the National Quality Forum. The phrase caught on, and there are now numerous organizations - including Medicare, Cigna and consumer watchdogs like the Leapfrog Group - that have jumped on the bandwagon to eliminate never events from the health care process.

Although the list has been tweaked here and there, and varies from organization to organization, never events basically encompass ugly incidents like surgery performed on the wrong body part, sponges or other surgical supplies retained in the patient post-surgery, pressure ulcers, and hospital-acquired infections due to untended surgical sites or improper use of catheters.

As disturbing, frightening and costly as never events are, however, there does not seem to be a clear corresponding reduction to their occurrence over time, even as awareness has increased.

As our health costs continue to rise at rates exceeding inflation, it is of extreme importance for payers in the health care system to become advocates on behalf of their members to ensure the network providers employ the best practices available to ensure patient safety.

At the county, 2010 was a particularly high claims year. Sure, we have all the common culprits within our population - an aging workforce, obesity, cancer, diabetes and heart disease.

But as I sit here with the responsibility for every penny spent on that health plan weighing on my mind, the exact amount of those dollars attributable to never events is unknown.

The particular facilities where the incidences are more prevalent are also unknown. These cost items must become transparent to employers, patients and insurers. If ever there was an argument for consumerism, this is certainly a good one.

This is not to suggest that these incidents aren't rare. I cut my teeth in health care risk management, and there are some dynamic and dedicated folks on the front lines in our nation's hospitals ensuring quality of care and patient safety.

But when these rare incidents do occur, the associated cost can be staggering. Although it's a noble step for insurers, employers and Medicare to refuse or reduce reimbursement for claims arising out of never events, the broader questions are: How do we find out about them? How do we ensure transparency?

There are initiatives in Congress to ensure all states develop reporting procedures for medical errors, but under this legislation, not all medical errors are considered never events as defined by Leapfrog and the National Quality Forum, and the states are in various stages of implementation.

Hospitals are required to report medical errors to the appropriate federal agencies, such as the Joint Commission, but those reports are not disclosed to the public. So when it comes to transparency, it's pretty easy to see that the nation is still working on it.

But we're all aware that the costs associated with never events are in the bottom line of our health plans. So, what can we do about it?

First, we can educate employees. If employees are aware of the risk of medical errors and can identify them if they happen to themselves or their covered dependents, they can subsequently report them to their health plan.

Secondly, we can get out there and meet the hospital administrators in our communities. Armed with the knowledge of how much of our health plan dollars are spent on local health providers, we can be in a position to encourage (meaning insist) those providers implement best practices in prevention.

Finally, we can keep up with and support the important efforts of organizations like the Leapfrog Group and local healthcare coalitions and lend our voices as concerned payers in the system.

As a health insurance purchaser, I will be very interested in those insurers that have taken a proactive approach to helping eradicate never events from the system. As we move into this new decade, which is prepped to be the decade of health care reform, let's work collectively to ensure never events are no more.

Contributing Editor Nancy L. Bolton is the director of risk management for the Palm Beach County Board of County Commissioners in West Palm Beach, Fla.Follow EBN on: Twitter | Facebook | LinkedIn | Podcasts