You don’t expect to pay for something that was done wrong. Starting October 1, 2008 the Centers for Medicare and Medicaid Services (CMS) have said they won’t either. The CMS will use its financial clout to improve patient safety and control costs by no longer paying for what are known as “Never Events”. Defined by several national quality measurement organizations, “never events” include surgical errors such as procedures performed on the wrong body part or on the wrong patient. In addition to wrong-site surgery and serious medication errors, “never events” also include a variety of other complications. Initially they started with 8 events but now have expanded the list to 11.
Because Medicaid is a state administered program and each state sets its own guidelines regarding eligibility and services, many states have chosen to expand the list to 28 medical errors as listed by The National Quality Forum. Once this happened many of the private health insurance companies have signed up and are not going to pay for errors which were preventable. The goals of the Never Event policy are two fold, one is patient safety and the other is to reduce or maintain costs. In the past the Medicare program has generally paid for services under fee-for-service payment systems, without regard to quality, outcomes, or overall costs of care, now that has changed.
When this was proposed in May, consumer advocates said they feared that some hospitals might charge patients for costs that Medicare refused to pay. But that is forbidden. “The hospital cannot bill the beneficiary for any charges associated with the hospital-acquired complication,” the final rules say.
While the exact number of “never events” is not known, they result in many deaths and additional healthcare costs. In 1999, the Institute of Medicine (IOM) estimated that as many as 98,000 deaths a year were attributable to medical errors. One must take into consideration that close to 45 million procedures were done in American hospitals during 2005, with 0.002% being the result of a medical error.
Information that hospitals report will be used to expand the CMS’s Hospital Compare program which can be used by one and all to compare hospitals.
The bad things about never events are:
1. There are no excuses. They just should not happen.
2. The results can have lasting affects on patients, their families as well as the medical staff.
3. They can be extremely expensive to resolve.
How will this turn of events effect hospitals
1. They will have to do a better job of screening employees and physicians that are granted practicing privileges.
2. Incoming patients will under a more detailed screening and additional tests to document all the patient’s conditions. Admissions will have a much greater role in the future.
3. Hospitals will have to do a more thorough job of reporting errors. Errors will become an open book which will result in embarrassment for some hospitals.
4. Good doctors will leave poorly performing hospitals for positions or privileges at better ones.
How will doctors be affected?
1. They will be more detailed in taking patients histories.
2. They will have a tendency to increase the number of tests run on patients.
3. They will prioritize their list of specialists for second opinions or specialized care.
4. They will refuse to collaborate with doctors that don’t meet their performance standards.
5. Hospitalized patients will be watched more closely.
How will this affect you, the patient, and what can you do to avoid a bad stay in the hospital?
1. Be prepared by maintaining your own copy of your medical history.
2. Work with your primary care physician on a preventative health program.
3. Know the hospitals in your area, their strengths and their weaknesses.
4. Primary care physicians will be more detailed in taking and maintain patient medical histories.
5. They will insist that hospitals perform to the highest standard.
The U.S. spends twice the amount of money per capita than what other major industrialized countries spend on health care, and costs continue to rise faster than income. We are headed toward $1 of every $5 of national income going toward health care. You should expect a better return on your investment.
Here’s what’s on the expanded list, including three items (listed first) that were added last month:
• Surgical-site infection after certain elective procedures, such as spine surgery, bariatric surgery for obesity and certain procedures to treat varicose veins
• Certain issues resulting from poor control of blood sugar levels, such as a diabetic coma
• Deep vein thrombosis (a blood clot in a major vein) or pulmonary embolism (a sudden blockage of an artery in the lung) after total knee replacement and hip replacement procedures
• Advanced bedsores occurring at the hospital
• A foreign object, such as a sponge or needle, inadvertently left in a patient after surgery
• Catheter-associated urinary tract infections
• Catheter-associated blood vessel infections
• An air embolism (bubbles of air or gas entering the bloodstream during surgery)
• Mediastinitis (infection of the area between the lungs) after coronary bypass surgery
• Giving patients the wrong blood type
• In-hospital falls and trauma such as a head injury
The National Quality Forum calls these 28 medical errors “never events,” meaning, of course, that they should never happen.
Surgical Events
* Surgery performed on the wrong body part
* Surgery performed on the wrong patient
* Wrong surgical procedure on a patient
* Retention of a foreign object in a patient after surgery or other procedure
* Intraoperative or immediately post-operative death in a normal healthy patient
Product or Device Events
* Patient death or serious disability associated with the use of contaminated drugs, devices, or biologics provided by the healthcare facility
* Patient death or serious disability associated with the use or function of a device in patient care in which the device is used or functions other than as intended
* Patient death or serious disability associated with intravascular air embolism that occurs while being cared for in a healthcare facility
Patient Protection Events
* Infant discharged to the wrong person
* Patient death or serious disability associated with patient disappearance for more than four hours
* Patient suicide, or attempted suicide resulting in serious disability, while being cared for in a healthcare facility
Care Management Events
* Patient death or serious disability associated with a medication error
* Patient death or serious disability associated with a hemolytic reaction due to the administration of ABO-incompatible blood or blood products (transfusion of the wrong blood type)
* Maternal death or serious disability associated with labor or delivery on a low-risk pregnancy while being cared for in a healthcare facility
* Patient death or serious disability associated with hypoglycemia, the onset of which occurs while the patient is being cared for in a healthcare facility
* Death or serious disability (kernicterus) associated with failure to identify and treat jaundice in newborns
* Stage 3 or 4 pressure ulcers acquired after admission to a healthcare facility
* Patient death or serious disability due to spinal manipulative therapy
Environmental Events
* Patient death or serious disability associated with an electric shock while being cared for in a healthcare facility
* Any incident in which a line designated for oxygen or other gas to be delivered to a patient contains the wrong gas or is contaminated by toxic substances
* Patient death or serious disability associated with a burn incurred from any source while being cared for in a healthcare facility
* Patient death associated with a fall while being cared for in a healthcare facility
* Patient death or serious disability associated with the use of restraints or bedrails while being cared for in a healthcare facility
Criminal Events
* Any instance of care ordered by or provided by someone impersonating a physician, nurse, pharmacist, or other licensed healthcare provider
* Abduction of a patient of any age
* Sexual assault on a patient within or on the grounds of a healthcare facility
* Death or significant injury of a patient or staff member resulting from a physical assault (i.e., battery) that occurs within or on the grounds of a healthcare facility
To see a complete list of States and their policies for “Never Events” click here.