Patient Safety Events
As part of Aetna's commitment to patient safety and quality, Aetna will not pay facility charges for "Never Events" (NE) and some "Serious Reportable Events" (SRE) as described below.
Aetna’s policy requires facilities to report all Patient Safety Events to Aetna.
The facility must waive all costs related to the NEs and charges directly and solely related to an SRE listed below. If we pay a claim for a NE or ineligible SRE procedure, we maintain the right to seek recovery of the overpaid charges.
If Aetna learns of a potential Patient Safety Event from another source, we will notify the facility and follow our policy.
“Never Event” (NE) is a surgical or invasive procedure is considered an NE if the procedure is not consistent with the documented informed consent of the member. For purposes of this policy, Aetna has determined the following events to be NEs:
- Surgical or invasive procedure performed on the wrong person,
- Surgical or invasive procedure performed on the wrong side or body part, or
- The wrong surgical or invasive service is rendered.
“Serious Reportable Event” is a potentially avoidable condition that could reasonably been prevented through application of evidence-based guidelines. SRE conditions are not present when the patient is admitted to a facility or the event is the sole reason for the admission. The following are a list of SREs in which the facility must waive all costs related to any of the events.
- Unintended retention of a foreign object in a patient after surgery or other invasive procedure
- Intraoperative or immediately postoperative/post procedure death in an ASA Class I patient
- Patient death or serious injury associated with the use of contaminated drugs, devices, or biologics provided by the health care setting
- Patient death or serious injury associated with intravascular air embolism that occurs while being cared for in a health care setting
- Patient death or serious injury associated with a medication error (e.g., errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation or wrong route of administration)
- Patient death or serious injury associated with unsafe administration of blood products
- Patient death or serious injury associated with a fall while being cared for in a health care setting
- Any stage 3, stage 4, or unstageable pressure ulcers acquired after admission/presentation to a health care setting
- Patient death or serious injury associated with an electric shock in the course of a patient care process in a health care setting
- Any incident in which systems designated for oxygen or other gas to be delivered to a patient contains no gas, the wrong gas or is contaminated by toxic substances
- Patient death or serious injury associated with a burn incurred from any source in the course of a patient care process in a health care setting
- Manifestations of poor glycemic control (i.e., diabetic ketoacidosis, nonketotic hyperosmolar coma, hypoglycemic coma, secondary diabetes with ketoacidocis, secondary diabetes with hyperosmolarity) while the patient is being cared for in a health care setting
- Deep vein thrombosis and/or pulmonary embolism following certain orthopedic procedures: total knee replacement or hip replacement
- Catheter-associated urinary tract infection (UTI)
- Vascular catheter-associated infection
- Surgical site infection following Coronary Artery Bypass Graft (CABG)-mediastinitis, bariatric surgery (i.e., laparoscopic gastric bypass, gastroenterostomy, laparoscopic gastric restrictive surgery), orthopedic procedures (i.e. spine, neck, shoulder, elbow), cardiac implantable electronic device (CIED)
- Iatrogenic pneumothorax with venous catheterization