Being an educated patient might be the best defense against medical errors. One of the most frequent factors in medical errors is poor communication. So if you’re familiar with your condition and ask good questions, you can do a lot to ensure safer care.

Never assume that each of your health care providers knows everything about your condition. Be an active partner in your health care. Use whatever information you have as a basis for better discussions with your doctor. The safety tips provided below can be used as a starting point:

• Be prepared for your visit. Have your questions written down and don’t be afraid to ask them.
• Learn as much as you can about your conditions and treatments.
• Don’t be afraid to ask all health care workers who have direct contact with you to wash their hands before caring for you.
• Ask a family member or friend to stay with you during appointments or hospitalizations so they can help you communicate and understand.
• If you are in the hospital or an outpatient setting, make sure each person checks your ID bracelet or verifies your name before giving you medications, treatments or procedures.
• Tell your physicians and pharmacist everything that you are taking. This includes prescription medicines, over-the-counter medicines, vitamins, herbs and dietary supplements. Always keep an updated list of medications with you.
• Ideally, get all of your medications from one pharmacy so it can help watch for potential drug interactions.
• Ask if there are any lab tests or other tests you should have regularly as long as you are taking the medicine.
• Ask your physician to explain any treatment plans in terms you understand.
• If you have a test, make sure you receive and understand what the result. Call your doctor’s office if you haven’t heard back within a reasonable amount of time.
• Ensure that each physician who is providing care to you is aware of the other physicians you are seeing, as well as the medications and treatments ordered by them.
• Understand that more treatment is not always better. Unnecessary treatment might cause harm.
• If you are having surgery, make sure that you, your physicians, and your surgeons agree on what will be done. Check your paperwork to make sure the correct procedure, including the correct location or side, is clearly documented. Make sure the correct site on your body is marked before surgery.
• Establish and maintain a personal health record that you share with your family.
• Be aware of any patient safety event that arises and discuss it with your health care providers. Be sure to tell your health care provider about any situation that may put your safety at risk.

Adverse Events

Anthem is a strong advocate for patient safety. We work collaboratively with the doctors and hospitals in our network to improve the quality of patient care by identifying measurable and preventable medical errors (known as “adverse events”).

Adverse events are unexpected, unintended or unwanted outcomes or injuries. Unfortunately, not all adverse events can be prevented. But we’re working with doctors and hospitals to reduce your risks, both medically and financially.

There are certain adverse events that should never occur in a health care setting. Our policy is that neither members nor their health plan should pay fees associated with the following types of events (also known as “never events”):

1. Surgery performed on the wrong body part.
2. Surgery performed on the wrong patient.
3. Wrong surgical procedure performed on a patient.

Other adverse events include hospital-acquired conditions (HACs) that have been identified by the Centers for Medicare and Medicaid Services (CMS). These are considered HACs only if the conditions were determined NOT to be present on admission. This determination is made by using what is called the present on admission (POA) indicator, which hospitals submit with their claims:

Our program is based on the CMS approach. Our policy support non-payment for the following hospital-acquired conditions:

1. Object left in the body during surgery.
2. Air embolism or blockage.
3. Blood incompatibility.
4. Catheter-associated urinary tract infection.
5. Vascular catheter-associated infection.
6. Pressure ulcers (stages 3 & 4).
7. Hospital-acquired injuries (falls and trauma): fractures, dislocations, intracranial injury, crushing injury, burn, and other unspecified effects of external causes.
8. Surgical site infection following:
   a. Coronary artery bypass graft – CABG (mediastinitis).
   b. Certain orthopedic procedures.
   c. Bariatric surgery for obesity.
9. Deep vein thrombosis (DVT) and pulmonary embolism (PE) following hip or knee replacement.
10. Manifestations of poor glycemic control (CMS) and patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a health care facility (NQF).

We are committed to working collaboratively with physicians and hospitals in its network to identify preventable adverse events that are measurable and can be prevented as a means of improving the quality of patient care.

Hospital Quality and Safety

What is the score on hospital quality?

Find out with the Quality-In-Sights® Hospital Incentive Program (Q-HIP®).

Q-HIP is an award-winning program that ties hospital payments to the quality of patient care. Currently, payments are tied to the number of services instead of the quality of care. The goal of the program is to help all patients get the best health care.

Hospitals are reviewed in three areas:

• Patient safety – This area looks at how the hospital's patient care processes align with nationally accepted best practices.
• Health outcomes – This area looks at how the results of a patient's care compares to other hospitals across the country.
• Patient satisfaction – This area looks at public patient survey results

Q-HIP measures are based on standards supported by nationally recognized quality groups. These include the Centers for Medicare & Medicaid Services (CMS), American College of Cardiology (ACC), the Institute for Healthcare Improvement (IHI), the Joint Commission (JC), the National Quality Forum (NQF), and the Society of Thoracic Surgeons (STS).

Q-HIP has grown from 16 hospitals in 2003 to more than 600 by the end of 2011. Q-HIP has won many awards but the program's growth is the best reflection of its success.

Legal Disclaimer:  Quality-In-Sights® and Q-HIP® are registered service marks of Anthem Southeast, Inc. and are used with permission.

Your active involvement can make a real difference in patient safety. Becoming an informed and involved consumer can help improve the quality of care that you or your loved ones receive. Please visit Questions Are the Answer, at the Agency for Healthcare Research and Quality website, for videos, tips and resources to help put you in the driver’s seat when it comes to your health.