Promoting Patient Safety: CIGNA to Stop Reimbursing Hospitals for Never Events and...

Thu Apr 17, 2008 10:00am EDT

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Promoting Patient Safety: CIGNA to Stop Reimbursing Hospitals for Never Events and Avoidable Hospital Conditions

BLOOMFIELD, Conn.--(Business Wire)--
As part of its ongoing focus on improving health care quality,
CIGNA HealthCare is taking steps to stop reimbursing hospitals for
so-called "never events" and avoidable hospital conditions, which are
errors in patient care that can and should be prevented. CIGNA's new
policy is consistent with and based on the policy of the Centers for
Medicare and Medicaid Services (CMS), and both policies will become
effective on Oct. 1, 2008.

   "CIGNA is committed to improving quality for our members
throughout the health care system," said Jeff Kang, MD, chief medical
officer for CIGNA HealthCare. "Our policy on never events and
avoidable hospital conditions is designed to put patient safety first
and to encourage hospitals to improve quality every day, one patient
at a time."

   "We commend CIGNA for its commitment to patient safety and quality
improvement," said Helen Darling, president of the National Business
Group on Health. "Hospitals, health care professionals and health
plans must all work together to ensure that 'never events' never
happen, avoidable conditions are always avoided, and every patient
receives quality treatment in a safe and caring environment."

   As defined in CIGNA's policy, "never events" are surgical
procedures that are performed on the wrong side, wrong site, wrong
body part or wrong person. They earned that name because they should
never happen in medical practice. For example, surgery erroneously
performed on the right knee instead of the left knee, or the erroneous
removal of a gall bladder instead of an appendix, are considered to be
never events.

   CIGNA will not reimburse for never events because they are not
"medically necessary." Surgery performed on the wrong side, wrong
site, wrong body part or wrong person is not considered medically
necessary to diagnose or treat an illness, injury or disease, and is
therefore not reimbursable.

   An avoidable hospital condition (also known as an acquired
hospital condition) is one that a patient does not have when admitted
to the hospital, develops during the patient's hospital stay, and
could have been avoided if the hospital had followed evidence-based
guidelines and best practices for patient care.

   Consistent with CMS policy, the avoidable hospital conditions that
CIGNA has identified as potentially non-reimbursable are: objects left
inside a patient during surgery; air embolism, or sudden artery
blockage from air bubbles introduced during surgery; use of the wrong
blood type during transfusions; infections from urinary catheters;
pressure ulcers, also known as bed sores; infections from central vein
catheters; mediastinitis, an often fatal inflammation in lung tissue;
and hospital-acquired injuries, such as fractures, dislocations, and

   CIGNA will stop reimbursement for these avoidable hospital
conditions when permitted under its hospital contracts. For example,
if a patient receives the wrong blood type during a transfusion, or a
surgical instrument is left inside a patient during surgery, and that
error prolongs the patient's hospital stay by two days, CIGNA would
deny reimbursement to the hospital for the additional two days when
permitted by contract. CIGNA's policy is designed to avoid member
liability for any payment denials to participating facilities.

   The policy is consistent with CIGNA's participation in or support
for a number of national quality organizations and initiatives,
including the National Quality Forum and the Leapfrog Group. CIGNA
encourages hospitals to adopt the Leapfrog guidelines on never events,
which call for hospitals to apologize to the patient and family
affected by a never event; report the event to at least one agency,
such as the Joint Commission on Accreditation of Healthcare
Organizations (JCAHO); perform a root cause analysis of the event; and
waive all costs directly related to the event.

   CIGNA provides measures of hospital quality through its Provider
Directory on When hospitals adopt the Leapfrog
guidelines they may receive a higher quality rating. The company plans
to enhance its hospital quality ratings by giving greater weight to
never events and avoidable hospital conditions once the new policy is

   About CIGNA HealthCare

   CIGNA HealthCare, based in Bloomfield, Conn., provides medical
benefits plans, dental coverage, behavioral health coverage, pharmacy
benefits and products and services that integrate and analyze
information to support consumerism and health advocacy. "CIGNA
HealthCare" is a registered service mark of CIGNA Intellectual
Property, Inc., licensed for use by CIGNA Corporation (NYSE:CI) and
its operating subsidiaries, including Connecticut General Life
Insurance Company. Products and services are provided by such
operating subsidiaries, and not by CIGNA Corporation. For more
information, visit

CIGNA HealthCare
Mark Slitt, 860-226-2092

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