• Member Statistics

    • 743,262 Colleagues-to-Date [Sponsored by a generous R&D grant from iMBA, Inc.]
  • David E. Marcinko [Editor-in-Chief]

    As a former Dean and appointed Distinguished University Professor and Endowed Department Chair, Dr. David Edward Marcinko MBBS DPM FACFAS MBA MEd BSc CMP® was a NYSE broker and investment banker for a decade who was respected for his unique perspectives, balanced contrarian thinking and measured judgment to influence key decision makers in strategic education, health economics, finance, investing and public policy management.

    Dr. Marcinko is originally from Loyola University MD, Temple University in Philadelphia and the Milton S. Hershey Medical Center in PA; as well as Oglethorpe University and Emory University in Georgia, the Atlanta Hospital & Medical Center; Kellogg-Keller Graduate School of Business and Management in Chicago, and the Aachen City University Hospital, Koln-Germany. He became one of the most innovative global thought leaders in medical business entrepreneurship today by leveraging and adding value with strategies to grow revenues and EBITDA while reducing non-essential expenditures and improving dated operational in-efficiencies.

    Professor David Marcinko was a board certified physician, surgical fellow, hospital medical staff Vice President, public and population health advocate, and Chief Executive & Education Officer with more than 425 published papers; 5,150 op-ed pieces and over 135+ domestic / international presentations to his credit; including the top ten [10] biggest drug and pharmaceutical companies and financial services firms in the nation. He is also a best-selling Amazon author with 30 published academic text books in four languages [National Institute of Health, Library of Congress and Library of Medicine].

    Dr. David E. Marcinko is past Editor-in-Chief of the prestigious “Journal of Health Care Finance”, and a former Certified Financial Planner® who was named “Health Economist of the Year” in 2010. He is a Federal and State court approved expert witness featured in hundreds of peer reviewed medical, business, economics trade journals and publications [AMA, ADA, APMA, AAOS, Physicians Practice, Investment Advisor, Physician’s Money Digest and MD News] etc.

    Later, Dr. Marcinko was a B.O.D member of Physicians Nexus, First Global Financial Advisors and the Physician Services Group Inc; as well as mentor and coach for Deloitte-Touche and other start-up firms in Silicon Valley, CA.

    As a state licensed life, P&C and health insurance agent, SEC registered representative Marcinko was Founding Dean of the fiduciary and niche focused on-line CERTIFIED MEDICAL PLANNER® chartered designation education program; as well as Chief Editor of the 3 print format HEALTH DICTIONARY SERIES® and online Wiki Project.

    Dr. David E. Marcinko’s professional memberships included: ASHE, AHIMA, ACHE, ACME, ACPE, MGMA, FMMA and HIMSS. He was a MSFT Beta tester, Google Scholar, “H” Index favorite and one of LinkedIn’s “Top Cited Voices”.

    Marcinko is “ex-officio” and R&D Scholar-on-Sabbatical for iMBA, Inc. who was recently appointed to the MedBlob® [military encrypted medical data warehouse and health information exchange] Advisory Board.

    entrepreneur

    Frontal_lobe_animation

  • ME-P Information & Content Channels

  • ME-P Archives Silo [2006 – 2019]

  • Ann Miller RN MHA [Managing Editor]

    ME-P SYNDICATIONS:
    WSJ.com,
    CNN.com,
    Forbes.com,
    WashingtonPost.com,
    BusinessWeek.com,
    USNews.com, Reuters.com,
    TimeWarnerCable.com,
    e-How.com,
    News Alloy.com,
    and Congress.org

    Comprehensive Financial Planning Strategies for Doctors and Advisors: Best Practices from Leading Consultants and Certified Medical Planners(TM)

    Product Details

    Product Details

    Product Details

  • CERTIFIED MEDICAL PLANNER® program

    New "Self-Directed" Study Option SinceJanuary 1st, 2018
  • PodiatryPrep.org


    BOARD CERTIFICATION EXAM STUDY GUIDES
    Lower Extremity Trauma
    [Click on Image to Enlarge]

  • Most Recent ME-Ps

  • ME-P Free Advertising Consultation

    The “Medical Executive-Post” is about connecting doctors, health care executives and modern consulting advisors. It’s about free-enterprise, business, practice, policy, personal financial planning and wealth building capitalism. We have an attitude that’s independent, outspoken, intelligent and so Next-Gen; often edgy, usually controversial. And, our consultants “got fly”, just like U. Read it! Write it! Post it! “Medical Executive-Post”. Call or email us for your FREE advertising and sales consultation TODAY [770.448.0769]

    Product Details

    Product Details

  • Medical & Surgical e-Consent Forms

    ePodiatryConsentForms.com
  • iMBA White Papers

    Customized Industry Topics [$1,500 unlimited corporate license]January 1st, 2019
    16 days to go.
  • iMBA Inc., OFFICES

    Suite #5901 Wilbanks Drive, Norcross, Georgia, 30092 USA [1.770.448.0769]. Our location is real and we are now virtually enabled to assist new long distance clients and out-of-town colleagues.

  • ME-P Publishing

  • SEEKING INDUSTRY INFO PARTNERS?

    If you want the opportunity to work with leading health care industry insiders, innovators and watchers, the “ME-P” may be right for you? We are unbiased and operate at the nexus of theoretical and applied R&D. Collaborate with us and you’ll put your brand in front of a smart & tightly focused demographic; one at the forefront of our emerging healthcare free marketplace of informed and professional “movers and shakers.” Our Ad Rate Card is available upon request [770-448-0769].

  • Reader Comments, Quips, Opinions, News & Updates

  • Start-Up Advice for Businesses, DRs and Entrepreneurs

    ImageProxy “Providing Management, Financial and Business Solutions for Modernity”
  • Up-Trending ME-Ps

  • Capitalism and Free Enterprise Advocacy

    Whether you’re a mature CXO, physician or start-up entrepreneur in need of management, financial, HR or business planning information on free markets and competition, the "Medical Executive-Post” is the online place to meet for Capitalism 2.0 collaboration. Support our online development, and advance our onground research initiatives in free market economics, as we seek to showcase the brightest Next-Gen minds. ******************************************************************** THE ME-P DISCLAIMER: Posts, comments and opinions do not necessarily represent iMBA, Inc., but become our property after submission. Copyright © 2006 to-date. iMBA, Inc allows colleges, universities, medical and financial professionals and related clinics, hospitals and non-profit healthcare organizations to distribute our proprietary essays, photos, videos, audios and other documents; etc. However, please review copyright and usage information for each individual asset before placement on your publication or web site. Attestation references, citations and/or back-links are required. All other assets are property of the individual copyright holder.
  • OIG Fraud Warnings

    Beware of health insurance marketplace scams OIG's Most Wanted Fugitives at oig.hhs.gov
  • Advertisements

“Never-Events” Payment Trends

Join Our Mailing List

Aetna and WellPoint Refuse to Pay for Medical Errors

By Staff WritersMedical Chart

According to The Wall Street Journal, some large private health insurers are following Medicare’s lead by refusing reimbursement for erroneous medical care. Aetna and WellPoint now have contract provisions stating their refusal to pay – or allow patient-balance-billing – for care related to the 28 “Never-Events” compiled by the National Quality Forum [NQF].  

These NEs include, death of a low-risk pregnancy mother, instruments left in-situ after surgery, and using contaminated instruments or medical devices. Of course, the very definition of some other NEs is hotly contested.

Significant Examples 

Nevertheless, Aetna is including contract provisions that bar payment for all 28 NEs. And, WellPoint is refusing payment for 4/28 NEs in the State of Virginia.

Other insurers, like UnitedHealth Group and Cigna are considering similar moves; as are all 39 members of the Blue Cross/Shield Association. Hospitals in Minnesota and Massachusetts have already agreed to not charge for all, or at least some, of the 28 never events identified by the NQF. 

Assessment

And so, is this a national economic trend whose time has come; or just an unfortunate quality-care issue gone wrong regarding the “law of unintended consequences?”  What are your thoughts? 

Channel Surfing the ME-P

Have you visited our other topic channels? Established to facilitate idea exchange and link our community together, the value of these topics is dependent upon your input. Please take a minute to visit. And, to prevent that annoying spam, we ask that you register. It is fast, free and secure.

Conclusion

Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com

OUR OTHER PRINT BOOKS AND RELATED INFORMATION SOURCES:

Product DetailsProduct DetailsProduct Details

Advertisements

13 Responses

  1. Pennsylvania’s hospitals announced yesterday that they will not charge for care related to serious medical mistakes such as wrong-body-part surgery and substantial medication errors.

    The announcement follows similar stands by hospitals in Massachusetts and Minnesota, as noted on this blog and elsewhere. But, it only applies to patients who are on public healthcare coverage, like the PA Medical Assistance program. The move, was announced by the Hospital & Health System Association of Pennsylvania

    QUERY: And so, am I to pay for mistakes and NEs because I am employed and have private health insurance overage – please opine – help me understand – and explain?

    -Cindy, RN

    As Dr. Phil would say; “is the word STUPID stamped on my forehead?”

    Like

  2. Brief Historical Review of the “Never-Events” policy

    The National Quality Forum’s [NQF] list of 28 Serious Reportable Events (sometimes called “never events” – medical errors that should never happen to a patient), is not exactly new.

    In fact, was initiated in 2006; prompting the Leapfrog Group to give public recognition to hospitals that agree certain steps should be taken whenever a serious reportable adverse event occurs in their facility.

    Through the 2007 Leapfrog Hospital Quality and Safety Survey, hospitals will be given the opportunity to receive public recognition for agreeing to do the following if a “never event” occurs within their facility:

    • Apologize to the patient and/or family affected by the never event.
    • Report the event to one organization; ie., JCAHO, state program or Patient Safety Org.
    • Perform a root cause analysis, consistent with the chosen reporting program.
    • Waive all costs directly related to the NE and refrain from seeking reimbursement from the patient or a third party payer.

    Of course, the issue is ever evolving as reported in the Executive Post.
    Source: Leapfrog Group, November 15, 2006
    -Linda

    Like

  3. Who Foots the Bill for Medical Errors?

    Another interesting and related post on Never-Events.
    http://www.msnbc.msn.com/id/23341360

    Best
    -Hope

    Like

  4. I am taking a healthcare policy class and need information on the development of a “never-events” policy. Do you know where to go for this?

    Thanks.
    Shannon Hoy

    Like

  5. Cindy, Linda, Hope and Shannon

    Are “Never-Events” No-Pay Policies Gaining Ground? You bet!

    Aetna just announced confirmaton of the new policy noted above, that refuses to pay for care related to a group of 28 adverse events, and require medical providers to take a series of reporting and corrective steps to address the errors.

    Link: http://www.fiercehealthfinance.com/story/aetna-refuses-payment-never-events-requires-corrective-action/2009-08-26?utm_medium=nl&utm_source=internal

    You are correct to ask how many other insurance companies will follow this lead, and when?

    Graham

    Like

  6. Wrong Sided Hand Surgery

    The fifth time is the charm:

    http://www.msnbc.msn.com/id/33470674/ns/health-health_care

    Adam

    Like

  7. Preventable Death-List Watch

    The US ranks at the bottom of 19 industrialized countries in preventable deaths.

    The Washington Post just reported on a study by the Commonwealth Fund published in the journal Health Affairs, that the United States ranks at the bottom of 19 industrialized nations in the number of preventable deaths by conditions such as diabetes, epilepsy, stroke, influenza, ulcers, pneumonia, infant mortality and appendicitis.

    Rank Country Preventable deaths per 100,000 population in 2002-2003

    1 France 65
    2 Japan 71
    3 Australia 71
    4 Spain 74
    5 Italy 74
    6 Canada 77
    7 Norway 80
    8 Netherlands 82
    9 Sweden 82
    10 Greece 84
    11 Austria 84
    12 Germany 90
    13 Finland 93
    14 New Zealand 96
    15 Denmark 101
    16 UK 103
    17 Ireland 103
    18 Portugal 104
    19 US 110

    Data Source: Commonwealth Fund, Health Affairs, World Health Organization

    Publication: The Washington Post, U.S. Losing Ground on Preventable Deaths, October 6, 2009. http://www.washingtonpost.com/wp-dyn/content/article/2009/10/05/AR2009100503798.html

    Victor

    Like

  8. Victor,

    Many thanks for the link above. Now, please allow me to offer you, and all ME-P readers, this one. It sould be titled: [Mis] Adventures in Cardiology

    http://adventuresincardiology.com/

    From Johns Hopkins Hospital, in Baltimore, no less!

    Shamus

    Like

  9. Never Events and Non-Payments

    Medicare and private insurers thought they were doing the right thing over the past two years by refusing to pay for additional hospital care for what they consider hospital-acquired conditions.

    But, some critics say that while their intentions are worthy, such do-not-pay policies haven’t worked in reducing these conditions, and payers should try some new approaches.

    http://www.fiercehealthpayer.com/story/guest-commentary-cms-no-pay-policy-hasnt-reduced-hospital-acquired-conditions/2010-08-16?utm_medium=nl&utm_source=internal

    What do ME-P readers think?

    Amy

    Like

  10. CMS Bars Medicaid Payments For Preventable Conditions

    Beginning on July 1, 2011, CMS will deny all Medicaid reimbursement requests associated with provider-preventable conditions, known as never events, reflecting a recent trend of payment policies aimed at lowering healthcare costs and increasing quality.

    The final rule, published June 6, 2011, implements Section 2702 of the ACA, and gives states one year to amend their individual Medicaid legislation for compliance.

    http://www.healthcapital.com/hcc/newsletter/06_11/cms.pdf

    Ann Miller RN MHA

    Like

  11. Update: N-Es

    On never-say-never events … again, by colleague Bob Wachter MD!
    http://community.the-hospitalist.org/2011/06/30/never-say-never-events/

    Hope Rachel Hetico RN MHA
    http://www.HealthcareFinancials.com
    [Managing Editor]

    Like

  12. N-Es

    The November issue of H&HN [Hospitals and Health Networks] just published an article on wrong site surgery, but I read about it on the ME-P first.

    Terry

    Like

  13. Process Improvement to Lower Surgery Risks

    Using Robust Process Improvement methods, several pilot hospitals and ambulatory surgical centers partnered with the Joint Commission to significantly reduce the number of surgical cases with risks and helped to develop a Targeted Solutions Tool™ for Wrong-Site Surgery.

    http://www.hhnmag.com/hhnmag/HHNDaily/HHNDailyDisplay.dhtml?id=7770007102

    Yep; technology rather than common sense!

    Adam

    Like

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s

%d bloggers like this: