St Vincent’s warns Medibank on talks

The head of St Vincent’s Health Australia yesterday backed Medibank’s calls for hospitals to ­improve standards.

The head of St Vincent’s Health Australia yesterday backed Medibank’s calls for hospitals to ­improve standards but he also warned that playing hard ball with hospitals would damage the ­insurer in the long run.

Toby Hall weighed into the fight between Medibank and Calvary Hospital, ignited after the insurer refused to re-sign a contract with Calvary because it would not agree to a list of incidents Medibank deemed were mistakes it would no longer pay for.

Mr Hall said there was room to move on both sides of the debate.

“Errors or preventable events are rare, but when they happen, hospitals should pay for them,” he said. “Hospitals need to accept their responsibilities for improving standards.”

But he said Medibank had to recognise that its list of 165 “highly preventable adverse events” for which it won’t pay and its “arbitrary condition” of refusing to fund hospital readmissions within 28 days was not based on any clinical reality.

“If Medibank — and increasingly others, such as Bupa and NIB — are genuine in wanting change for the benefit of patients, they’ll find hospitals are ready to work with them,” he said.

“But it needs to be more than lip service. First, health insurers and hospitals should be able to settle on a clinical basis for contesting preventable incidents.”

Medibank, which releases its annual results on Friday, defended its stance on the issue, saying that the primary ­objective of its approach was not about saving money but about preventing mistakes that it believes are avoidable.

Andrew Wilson, Medibank’s executive general manager of provider networks and integrated care, said the list of what it decided were mistakes was based on a thorough review of Australian and international evidence and had been refined in discussions with healthcare partners.

“We have only focused on a small number of mistakes where there is good evidence that they can be prevented,” he said.

Mr Wilson also said that on the 28-day readmission rule, the private health insurer ­acknowledged there were several conditions that required multiple admissions. He said these were excluded from this rule, including where the principle reason for ­admission to hospital was cancer, chronic heart failure, chronic obstructive pulmonary disease and palliative care.

“We see little controversy in partnering with hospitals to improve what the evidence suggests are unfortunate and preventable mistakes, which would directly benefit patients and help keep healthcare affordable,” he said.

Mr Hall, the head of the nation’s largest Catholic not-for-profit health and aged-care provider, said by working more closely together, private funds and hospitals could also find ways to further lower costs for patients, improve outcomes for the chronically ill and shed light on healthcare’s more opaque practices.