Archive for the ‘Never Events’ Category

Thank you to all of you who attended our webinar on Never Events.  click here to see the entire presentation.

Tuesday September 22nd, Adam V. Russo, Esq. along with Jason Davis of Global Excel Management and Stacy M. Borans, MD of Advanced Medical Strategies shared their presentation ”Flaws and Disorder: Never Event Unit”at the 2009 SIIA National Educational Conference & Expo in Orlando, FL. 

Click here to see the entire presentation

by Jason C. Davis of SIIA, www.siia.org   

Though rare, Never Events do happen. In fact, leaving a sponge behind in surgery was such a measurable occurrence that there are now surgical sponges inserted with radio chips to ensure that they are not forgotten (www.clearcount.com). Read more

May 19th, Adam V. Russo, Esq. spoke at the TABA 2009 TPA College of Knowledge Conference held at the Renaissance Hotel in Richardson, TX.

Click  here to see Attorney Russo’s entire presentation.

In the spring 2009 issue of the Texas Association of Benefit Administrators- The Benefit, you will find Adam V. Russo’s latest article “Never Events”.

click here to see Adam’s article.

For years, The Phia Group has argued that requisite signed subrogation agreements are a mistake. Often, plan documents include language which states that if a third party may potentially be responsible for charges, the Plan will not process these charges without a signed subrogation agreement from the plan member. Read more

The Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (the Parity Act) was passed on October 3, 2008, and was signed into law by President Bush the same day it passed Congress. The compliance date for each health plan is the annual renewal that occurs 12 months after the date the Parity Act became law (October 3, 2008). The Parity Act states that the law must be complied with even if the regulations have not been published by the effective date of compliance. Therefore, employers need to begin to evaluate their plan designs and establish a strategy for compliance. Read more

Having reviewed hundreds of Usual and Customary (”U&C”) and Medical Necessity provisions, contained within various employee benefit plans, and spending countless hours reviewing U&C and Medical Necessity topics with some of the best medical bill review firms in the country, The Phia Group has determined which terms result in a strong right to monitor claims for U&C, and which provisions leave the Plan helpless in the face of excessive charges. Read more

Many of The Phia Group’s clients feel that they are caught between a rock and a hard place. Either they thoroughly process a claim, confirming coverage in accordance with the terms of the applicable plan document, or they get claims paid within deadlines set by prompt payment laws. The bottom line is that many administrators feel they cannot do their job in the time they are forced to work with. Read more

It is imprudent to address “Never Events” by name in your plan document or policy. As a new issue, there is no concrete definition agreed upon by the industry. This can result in considerable confusion when determining what is payable, and what is actually a “Never Event.” Due to the uncertainty intrinsic to this topic, administrators and carriers should be more creative when addressing situations that may constitute Never Events. Read more

A. Never Events Defined

No universal definition exists for Never Events. That is why, for now, it is wise to avoid mentioning them in your plan document and policy language.

For now, we can generally agree that “Never Events” are services, supplies, care and/or treatment that results from errors in medical care that are clearly identifiable, preventable, and serious in their consequence for patients, including but not limited to air embolism, blood incompatibility, object left during surgery, catheter-associated urinary tract infections, pressure (decubitus) ulcers, vascular catheter-associated infection, surgical site infection, mediastinitis after coronary artery bypass graft (CABG) surgery, surgery performed on the wrong body part, surgery performed on the wrong patient, wrong surgical procedure performed, criminal events (e.g., sexual assault of a patient), falls and trauma, burns, electric shock, Legionnaires disease, failed glycemic control (e.g., Diabetic Ketoacidosis, Nonketotic Hyperosmolar Coma, Diabetic Coma, Hypoglycemic Coma), iatrogenic pneumothorax, delirium, ventilator associated pneumonia, staphylococcus aureus septicemia, clostridium difficile-associated disease (CDAD), and hospital-acquired injuries. Read more

Click here to see the Never Events Policy.

Robin J. Fisk, Esq., Fisk Law Firm

Inception by

In 1999, the Institute of Medicine issued a report finding that medical errors were a leading cause of mortality and morbidity in the United States, exceeding deaths attributable to motor vehicle accidents, breast cancer and AIDS.(1) The report, concluding that medi[i]cal errors contributed to 98,000 deaths per year, “ignited public and professional dialog.”(2)

Following this report, in 2002 the National Quality Forum (”NQF”),(3) an organization created to develop quality standards and measure and encourage reporting endorsed a list of 27 serious, largely preventable conditions in which, it claimed should never happen to a hospital patient.(4) A 28^th was added in 2006. The list included preventable errors arising from surgery, medical devices or products; inadequate patient protection; inadequate care management; unclean or unsafe environmental conditions; or criminal acts. The intent was to create national consensus around a common set of adverse events which needed to be investigated, analyzed for root cause and reported any time they occur – and the list was the start. Read more