Patient Safety at HMSA

At HMSA, we want to help keep our members safe and protected. That’s why we’ve incorporated a number of standards and procedures to reward quality health care and keep medical errors minimal.

Why is Patient Safety So Important?

Since patient safety was first brought to light in the 1990s, studies have shown a staggering number of patients harmed by preventable medical errors. These errors include systems failures, human factors, complicated technologies, powerful drugs, prolonged hospital stays, and cost-cutting measures, to name a few. Medical errors can cause serious injury or death and result in billions of dollars in excess health care costs nationwide each year. The World Health Organization (WHO) estimates that one out of every 10 patients worldwide is impacted by these errors.

What is HMSA Doing To Help Ensure Patient Safety?

HMSA has established a patient safety committee to work on new and existing patient safety initiatives. We’ve highlighted just a few of them below:

BCBSA Safety Collaborations

Never Events and Hospital Acquired Conditions

HMSA recently adopted the Centers for Medicare and Medicaid Services’ (CMS) ‘Never Events’ program. Never Events are defined as adverse events or errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients. The program focuses on improving quality by avoiding preventable situations with adverse outcomes in hospitals. Under this policy, providers and/or hospitals will no longer be reimbursed for certain preventable errors occurring after a patient’s admission to a hospital that lead to death, disability or unnecessary costs. HMSA is following CMS’ lead and aligning its payment policy to be consistent with CMS.

As of Jan. 1, 2010, HMSA will not reimburse providers of HMSA members for CMS’ 15 identified Never Events and Hospital-Acquired Conditions (Note: this program doesn’t apply to The HMSA Plan for QUEST Members.) These include surgery on the wrong patient, surgery on the wrong body part, wrong surgical procedure on a patient, foreign object left in patient, and patient death or serious disability due to incompatible blood or blood products.

To view the current HMSA medical Policy please click the following link: Never Events and Hospital-Acquired Conditions.

On the CUSP: STOP BSI

According to the Centers for Disease Control and Prevention, there are about 80,000 episodes of bloodstream infections due to central-line catheters each year in the United States, and more than half of them are preventable.

HMSA is providing funding and support for Hawaii to participate in a national effort to eliminate deadly catheter-related bloodstream infections in hospitals. ‘Stop Bloodstream Infections’, an initiative developed by the Johns Hopkins University Quality and Safety Research Group, has generated significant results nationwide. Since Hawaii was accepted to participate in the collaboration, HMSA has been working with all 17 hospitals with intensive-care units in Hawaii to reduce deadly infections related to the use of catheters. There has been a decline in the number of catheter-related bloodstream infections in Hawaii's hospitals since this campaign began.

In addition to reducing bloodstream infections, this program promotes a culture of safety that can be expanded to other hospital-improvement programs.

Radiation Safety

To promote the appropriate utilization of advanced diagnostic imaging in cases where traditional imaging would provide sufficient diagnostic information to treat the member or where another imaging study would be more appropriate based on the patient’s condition, HMSA has contracted with National Imaging Associates, Inc. (NIA) to provide precertification services.

Effective January 1, 2009, all advanced imaging studies require precertification through NIA.

For more information on radiation management and safety see:

• Facility Role in Providing Technical Services for Procedures Requiring Precertification
• Frequently Asked Questions: Radiology Management (click on Radiology Management).
• HMSA’s Business Association with NIA
• Physician Responsibility for Obtaining Precertification of Imaging Studies
• Radiology Guidelines for Advanced Imaging Studies

To view articles by our vendor on radiation management and safety, please click the links below:

• Ionizing Radiation Exposure From Radiologic Imaging: The Issue and What We Can Do [PDF]
• The Overuse of CT Scans Can Result in Cancer Deaths [PDF]

Surgical Safety Checklist

In an effort to help improve the safety of surgery patients around the world, the WHO developed the Safe Surgery Saves Lives Checklist in 2008. With the input of worldwide medical professionals, the 19-point checklist for surgeons was developed and piloted in hospitals in eight cities. Deaths and complications dropped by about one-third in the participating hospitals.

In response to the success of the WHO pilot program, the Blue Cross and Blue Shield Association (BCBSA) adopted the Blue Surgical Safety Checklist and is encouraging participating hospitals nationwide to use it. HMSA is supporting this effort by urging hospitals in Hawaii to adopt the checklist and by sharing it with members and urging them to discuss it with their surgeon.

Currently, hospitals in Hawaii are beginning to pledge to adopt the WHO or BCBSA Surgical Safety Checklist [PDF].

Please click the links below for more information on surgical safety, previously published in HMSA’s Provider Updates:

• April 2010 Provider Update for Participating Medical Practitioners [PDF]
• April 2010 Provider Update for Participating Healthcare Facilities [PDF]

Working With You

At HMSA, patient safety is a top priority. We’re excited to offer these additional safeguards to our members and are encouraged by the cooperation we’ve received from providers and hospitals. We hope you will continue to work with us to keep patients safe and secure with their health care needs and to help foster HMSA’s goal of working for a healthier Hawaii.

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