2023 4 CMS no longer reimburses health care providers for services that are required to treat

  

4-CMS no longer reimburses health care providers for services that are required to treat certain complications of care. The complications of care have been nick-named “never events” because according to CMS, these events should never happen and are “reasonably preventable by following evidence-based guidelines.” Examples of these never-events include, stage III and IV pressure ulcers, PE or DVTs after certain surgeries, injuries resulting from falls while in-patient, retention of foreign object after surgery, surgery on the wrong body part, surgical site infections after certain surgeries, transfusion of the wrong blood type, and UTI resulting from a catheter.

Some of these events are reasonable. There is simply no excuse to operate on the wrong body part and if a physician makes the mistake of leaving a foreign object in someone after surgery, it is reasonable to not pay them for another surgery to remove it. However, some of these events are going to happen even if every precaution has been taken to prevent these events. DVTs and PEs are still possible even when someone is on heparin or lovenox. Regardless of exactly “how” preventable these conditions are, this change by CMS will certainly cause providers in in patient facilities to be more attentive in their care and prevention of these conditions. Because CMS specifically mentions that these events are preventable by evidence-based guidelines, in patient care models are focusing even more on these guidelines and basing their care off of them. For example, most hospitals now have protocols to prevents CAUTIs, such as requirements to perform and document catheter care, and algorithms for early removal of catheters, and prevention of unnecessary insertion of catheters in the first place.

Reference:

O’Rourke, P. T., & Hershey, K. M. (2018, September 14). Never-Event Implications. Retrieved from https://www.the-hospitalist.org/hospitalist/article/124081/never-event-implications

 

 

 
 

5-The Centers for Medicare & Medicaid Services or CMS is investigating ways that they can help to reduce or eliminate the occurrence of “never events” (ELIMINATING SERIOUS, PREVENTABLE, AND COSTLY MEDICAL ERRORS – NEVER EVENTS, 2006). These events are defined as errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients. “Never events,” like surgery on the wrong body parts or mismatched blood transfusions can cause serious injury or death to patients. There is not an exact number of “never events” but they are the cause in many deaths and additional health care costs that the CMs is trying to minimize. The rules for reimbursement are changing. The Deficit Reduction Act allows CMS to begin adjusting payments for hospital-acquired infections and reduce the payments when they occur. This has caused for a shift in how hospitals require nurses to care for their patients. At my hospital, they implemented 4eyes on upon admission. This means that two registered nurses must assess every square inch of a patient’s body upon admission to insure that the hospital is not responsible for previously acquired injuries. This helps to prevent unnecessary cost on our part treating wounds that were acquired at home. We still treat them but we are not shown as responsible for their development.

ELIMINATING SERIOUS, PREVENTABLE, AND COSTLY MEDICAL ERRORS – NEVER EVENTS. (2006, May 18). Retrieved April 2, 2019, from CMS.gov: https://www.cms.gov/newsroom/fact-sheets/eliminating-serious-preventable-and-costly-medical-errors-never-events

 

 

 
 

6-The CMS reimbursement rules for never events required a shift in the patient care delivery model in inpatient facilities as this caused facilities to provide more quality based care to prevent the possibility of not getting paid for services that would be considered acquired through the facility. Many of the patients that come into the hospitals should be coming for their reasons for treatment not acquiring any other conditions due to their stay. Hospitals would be denied any additional payment for case in which one of the selected conditions was not present on admission. This caused many hospitals to panic and they attained means in order for this to be avoided. Due to this, facilities have developed distinct protocols and measures to make sure that this doesn’t occur. These conditions are known as never events, which include:

1. Air embolism
2. Blood incompatibility
3. Catheter-associated urinary tract infection
4. Certain manifestations of poor control of blood sugar levels
5. Deep-vein thrombosis or pulmonary embolism after total knee and hip replacements

2. Falls/trauma
7. Objects left in during surgery
8. Pressure ulcers
9. Surgical-site infections after certain orthopedic and bariatric surgeries
10. Surgical-site infections after coronary artery bypass graft
11. Vascular catheter-associated infection

Reference:

ESBCO Host. (n.d.). Preventing Never Events. Retrieved April 2, 2019, from https://www.ebscohost.com/shared/never-events.pdf.