Washington Post Examines CMS 'Never Events' Reimbursement Policy

Main Category: Medicare / Medicaid / SCHIP
Article Date: 22 Oct 2008 - 11:00 PDT

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The Washington Post on Tuesday examined a CMS decision to deny reimbursements to hospitals for so-called "never events," such as infections, bed sores and other "reasonably preventable" treatment errors that occur during hospital stays (Skrzycki, Washington Post, 10/21).

Medicare on Oct. 1 halted payments to hospitals for additional care resulting from "reasonably preventable" errors. Hospitals also were banned from charging patients directly for care related to medical errors. Under the rule, Medicare no longer will reimburse hospitals for the treatment of certain "conditions that could reasonably have been prevented." The conditions for which Medicare no longer will reimburse hospitals for treatment include: falls; mediastinitis, an infection that can develop after heart surgery; urinary tract infections that result from improper use of catheters; pressure ulcers; and vascular infections that result from improper use of catheters. In addition, the conditions include three "never events": objects left in the body during surgery, air embolisms and blood incompatibility.

The rule was proposed by CMS in April 2007 and mandated by a 2005 law. The new regulations are expected to affect hundreds of thousands of the 12.5 million hospital stays for which Medicare pays annually. The move is not expected to result in major reductions in expenses -- $21 million of the program's $110 billion in annual spending on beneficiary care -- but it "carries great symbolism in the Bush administration's efforts to revamp the country's medical payment system" (Kaiser Daily Health Policy Report, 10/1). According to the Post, CMS might add more preventable conditions to the list, including certain surgical mistakes, and might expand the policy to outpatient settings. Herb Kuhn, deputy administrator for CMS, said he hopes the decision will instigate a change in quality for hospitals. "When you enter a hospital, you don't want to leave with something else. Let's get it right the first time," Kuhn said.

Nancy Foster, vice president of quality and patient-safety policy at the American Hospital Association, said that there are items on the never events list that hospital staffs cannot prevent, such as bed sores caused by a prior skin condition or falls by patients who elect not to call a nurse for help in moving. J. James Rohack, president-elect of the American Medical Association, said Medicare should research these types of problems rather than CMS employing a "pay for perfection" system. He said the new system is not supported by science and that it may result in some procedures not being done on high-risk patients. Paul O'Neill, a former Treasury secretary who has been involved in several health care initiatives, suggested Medicare fund demonstration programs in hospitals to specifically work on eliminating errors. According to the Post, O'Neill, citing an analysis in Pennsylvania that found hospitals underreport mistakes, also is concerned that the policy could lead to a reduced rate of reported errors (Washington Post, 10/21).

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