Risk Watch e-column
January 2007
An update of risk management news, issues and items of interest
Number, Please
In an effort to speed reimbursements and make billing more efficient, the Centers for Medicare & Medicaid Services (CMS) are requiring that providers obtain a national provider identifier (NPI). This unique identifier will belong to the provider for life and be used in all electronic transactions. Without it, providers will not be reimbursed.
The deadline for requesting an NPI is May 23, 2007. When this date is reached, Medicare, Medicaid, and most private plans will only be accepting claims with NPIs. According to a report in the December 1, 2006, issue of Medical Economics there are 2.3 million covered entities that are required to have an NPI. These include physicians, hospitals and suppliers. About 1.2 million of these providers have not applied for their identifier. It is unknown how many physicians are among this group.
An NPI is needed by any provider who performs electronic transactions subject to the standards of HIPAA (Health Insurance Portability and Accountability Act). However, the Medical Economics report advises that even those practices that currently submit claims on paper should get an NPI.
Official information and applications are available online from the CMS at www.cms.hhs.gov/NationalProvIdentStand
(Source: Medical Economics)
Wrong-Site Surgery: Bigger Problem than Once Thought
Wrong-site surgery is probably one of the most devastating mistakes a physician can make. The danger of surgery on the wrong body part or even wrong patient continues to be a cause for concern. Indeed, physician and patient advocacy groups as well as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have worked vigorously to eliminate these errors by, among other things, having doctors and/or patients mark the surgery site before the fact.
But, in spite of these efforts, wrong-site mistakes continue to occur. The September 2006 issue of Archives of Surgery reported that the problem may be 20 times more common than thought, and prevention efforts have been inadequate. The report’s authors used four separate databases, including the federal government’s National Practitioner Data Bank, to track the number of wrong-site surgery occurrences. Their finding: Wrong-site surgery occurs between 1,300 and 2,700 times per year in the United States.
Since 2004, JCAHO has required that operating room staff verify the patient’s identity and confirm the procedure to be performed. However, it hasn’t required the reporting or investigation of wrong-site errors, thus the effectiveness of this strategy is unknown.
Reporting and investigation should be required, according to the study’s authors. This would enable careful analysis of why problems occurred and prevent future ones. Among the solutions they offer are bar coding and verifying with patients the nature of their procedures, but only within a context of built-in redundancies.
(Source: Archives of Surgery)
Patient Safety Goes International
Thanks to the World Health Organization (WHO), the improvement of patient safety has become an international priority. WHO’s program, Action on Patient Safety (also known as the High 5s initiative), has as its goal to achieve significant, sustained and measurable reduction or elimination of the following five safety problems over a five-year period:
- Patient care hand-over errors
- Wrong site/wrong procedure/wrong person surgical errors
- Continuity of medication errors
- High-concentration drug errors
- Poor hand hygiene practices.
The program builds on a partnership established by the Commonwealth Fund with Australia, Canada, New Zealand, the United Kingdom and the United States. The project is being coordinated by the WHO Collaborating Centre, which is led by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and its affiliate Joint Commission International.
(Source: JCAHO)
