CMS reimbursement rules for never events

Never events

How the CMS reimbursement rules for never events required a shift in the patient care delivery model in inpatient facilities

Never events happen to be serious, largely preventable patient’s safety incidences that should never occur with the effectiveness of precautionary measures that have been implemented in the medical facilities (Milstein, 2009). The primary care trusts are mandated to monitor the never events as the publicity reports indicate annually to assess the level of competence in the medical facility as never events can be one of the factors used to measure the effectiveness of a medical facility. The term never event first introduction was on 2001 by Ken Kizer who was the former CEO of National Quality Forum (NQF) (Milstein, 2009). The main reason for its reference was medical errors that could never have occurred if proper precautionary measures were taken and put in place in the medical facilities. The never events could be associated with deaths in the medical facilities as well as increased series of disabilities and this are some of the factors that can be associated with medical facilities failures as well as loss of customer loyalty (Milstein, 2009).  The categories of never events have been grouped into surgery, patient’s protection, product and device, care management, criminal, radiologic and environmental.

The never events are although rare and research was done in 2008 showed that a wrong suite surgery could be experienced in a hospital once in every 5-10 years (Bazzoli, 2008). However, it should be noted that when never events occur they are fatal as they end up adversely affecting the health conditions of a patient which should lead to disability or even death.

The Centers for Medicare & Medicaid Services (CMS) is mandated to oversee most of the healthcare programs which has been aimed towards streamlining the health conditions of the patients (Bazzoli, 2008). Due to precautionary measures that should be taken in medical facilities to prevent the never events, the CMS should come up with regulatory measures that should ensure that those that are directly linked with never events due to neglect or medical errors that could be avoided are answerable to the same. This could heighten and enforce the precaution measures that the medical team take when handling some of the patient’s conditions and therefore greatly reducing the cases. The Centers for Medicare & Medicaid Services (CMS) have also continued to emphasize that a patient should not leave the hospital without being discharged as this could worsen the condition and therefore affecting the medical facilities reparation as this could also be associated with neglect or errors. CMS also calls upon the medical team that is the nurses and the physicians to take precautions when handling the patients as this could go a long way towards preventing the occurrence of never events.

References

Bazzoli F. (2008). Final CMS rule adds ‘never events’ that Medicare won’t pay for.  Retrieved from: http://www.healthcarefinancenews.com/news/final-cms-rule-adds-never-events-medicare-wont-pay

Milstein, A. (2009). Ending extra payment for “never events”—stronger incentives for patients’ safety. New England Journal of Medicine, 360(23), 2388-2390. Retrieved from: http://www.nejm.org/doi/full/10.1056/NEJMp0809125#t=article

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