Dr Fragen in the operating room

Never Events


In October, 2007 CMS (Medicare) proposed a list of eight _preventable_ conditions that result in a prolongation and increase in cost of care to the hospitalized patient. These are what CMS terms **_never events_**. CMS is trying to couch this in terms of _patient safety_ but if you look at the list, there are only a few of these items that are 100% preventable. It’s really less about patient safety and more about how CMS can cut reimbursement. Medicine isn’t an exact science and expecting it to act as one is irrational.
On April, 14 2008 [CMS proposed additions to their **_never event_** list][1]…
> The HAC provisions in Medicare regulations required hospitals to begin reporting on their Medicare claims on October 1, 2007, whether certain specified diagnoses were present when the patient was admitted. The first eight conditions, which were selected last year because they greatly complicate the treatment of the illness or injury that caused the hospitalization, resulting in higher payments to the hospital for the patientā€™s care by both Medicare and the patient, were:
> * Object inadvertently left in after surgery
> * Air embolism
> * Blood incompatibility
> * Catheter associated urinary tract infection
> * Pressure ulcer (decubitus ulcer)
> * Vascular catheter associated infection
> * Surgical site infection- Mediastinitis (infection in the chest) after coronary artery bypass graft surgery
> * Certain types of falls and trauma
> CMS is proposing to expand the list of conditions that need to be reported if present when a patient is first admitted and is seeking public comment on whether they should be added to the list in the final rule to be announced later this year. The list in the proposed rule includes:
> * Surgical site infections following certain elective procedures
> * Legionnairesā€™ disease (a type of pneumonia caused by a specific bacterium)
> * Extreme blood sugar derangement
> * Iatrogenic pneumothorax (collapse of the lung)
> * Delirium
> * Ventilator-associated pneumonia
> * Deep vein thrombosis/Pulmonary Embolism (formation/movement of a blood clot)
> * Staphylococcus aureus septicemia (bloodstream infection)
> * Clostridium difficile associated disease (a bacterium that causes severe diarrhea and more serious intestinal conditions such as colitis)
Some of the biggest problems in this list are twofold.
1. Who’s to define things like derangement and what constitutes delirium?
2. If these are **_never events_** can someone please tell me how to avoid them 100% of the time?
All invasive procedures, and I include having a foley and being on a ventilator as invasive, carry risk. The risk is small but it exists and it is not zero. I seems what CMS is seeking to do is to transfer the risk from the _receivers_ of medical care to the _providers_ of medical care.
Personally, I think this list will ever expand and eventually hospitals and physicians will cease to be paid for any care arising out of these **_never events_**. When that starts happening, watch out. All of a sudden it will not make financial sense for hospitals and doctors to participate with Medicare.


2 responses to “Never Events”

  1. Andy Avatar

    I don’t really know. It’s a direct quote from CMS and I couldn’t see that it’s specified anywhere.

    I imagine any fall in the hospital.