The Never Event Plan from Centers for Medicare and Medicaid Services
Research indicates that about 44000 to 98000 deaths take place yearly within the US resulting from preventable medical errors (Kohn, Corrigan & Donaldson, 2010). According to reports by CDC, in the year 2002, about 99000 deaths occurred due to preventable or avoidable hospital-acquired infections (Klevens et al., 2009, p. 160). Moreover, studies reveal that medical errors can account for over 2.4 million additional hospital days as well as 9.3 billion USD in excess charges (Kohn, Corrigan & Donaldson, 2010). As a result, of these alarming statistics as well as shocking medical errors, efforts have existed to enhance the delivery of medical care as well as to improve accountability for and to report adverse events resulting from the systems of health care.
One such endeavor is supported by NQF, an NGO with diverse stakeholders within the private, and public health sectors. National Quality Forum was instituted or founded in the year 1999. Its mission was to enhance the America's quality health care via a range of ways (Kohn, Corrigan & Donaldson, 2010). In the year 2002, the National Quality Forum approved or endorsed 27 largely preventable. These adverse events were considered of concern to healthcare professionals, providers, and the public; clearly identifiable as well as measurable and of degree such that the occurrence risk is significantly affected by the policies, as well as procedures or events of the healthcare management (Kohn, Corrigan & Donaldson, 2010). The events were classified as being linked to products or devices, surgery, care management, criminal acts, patient protection, or the environment.
The experience of Minnesota has revealed that consistency exist ranging from one hundred to one hundred and fifty never events nationwide every year (Kohn, Corrigan & Donaldson, 2010). Other ten states currently need hospitals to track, assess, as well as publicly report all or some of the National Quality Forum never events. As much as reporting is the right direction or step, stronger incentives can be required; studies have revealed that public reporting is helpful at initiating change compared to the combination of financial punishments and reporting (Lindenauer et al., 2009, p. 496). The CMS is establishing patient safety as well as accountability a priority through starting its program of never event.
The current system of Medicare reimbursement, used by most insurers, is dependent on a scheme of perverse payment that offers incentives for undesired behavior. Within this system, healthcare facilities and hospitals are compensated for every condition or ailment for which the client is treated while in a hospital, entailing those, which develop because of preventable harm. Payments of hospital for Medicare clients are dependent on DRGs (Diagnosis-Related Groups). A Medicare hospitalization of the patient is assigned or given to one of the 538 Diagnosis-Related Groups, arrived at through the principal diagnosis, extra diagnoses, as well as procedures carried out on the patient. Clients in similar Diagnosis-Related Groups are required to use an equal amount of resources in the hospital. The Diagnosis-Related Groups system offers increased repayment for some complications and conditions, irrespective of whether the condition or complication was present during an admission or acquired within the hospital (Kohn, Corrigan & Donaldson, 2010).
Hospital-acquired conditions chosen include serious preventable events; for example, object left in position during surgery, serious preventable event like air embolism. Moreover, serious preventable event like blood incompatibility, catheter-linked urinary tract diseases, pressure ulcers, and vascular catheter-linked infection. Surgical site infection, for example, mediastinitis subsequent to graft of coronary artery bypass, and hospital-acquired injuries like falls, dislocations, fractures, intracranial injury, crushing injury, as well as other un-stipulated effects from external causes (Kohn, Corrigan & Donaldson, 2010).
New policies, which withhold reimbursement also, have the risk of promoting gaming of the scheme or system. In spite of the intent to create health care more accountable and transparent, the Centers for Medicare and Medicaid Services never-event plan can be a deterrent to the adverse events reporting. No health care worker can be willing to report an error if the outcome is punishment; punitive measures obviously leads in less reporting compared to one, which is rewarding or neutral. The Centers for Medicare and Medicaid Services no-pay initiative may lead to significant unintended consequences like the delay or denial of care to some at-risk patients (Klevens et al., 2009, p. 166). Hospitals can also be unfairly penalized if the preventable adverse events or conditions are not preventable although unavoidable and take place at some rate, despite whether safe, standard actions or practices are followed.
It is undisputed that medical errors should be eliminated or stopped within systems of healthcare. How best to achieve this aim, however, remains unclear. Centers for Medicare and Medicaid Services, together with other institutions, are putting efforts to get better the situation although these are never the final solution either. Every plan should be cautiously monitored, scrutinized, as well as adjusted to eliminate unfair or undesirable results. Since every interested party is affected differently, each stakeholder should be involved in the monitoring and feedback process.
References
Klevens, R. M., Edwards, J. R., Richards, C. L., Horan, T. C., Gaynes, R. P., Pollock, D. A., & Cardo, D. M. (2009). Estimating Health Care-Associated Infections and Deaths in U.S. Hospitals, 2002. Public Health Rep, 122(2), 160-166.
Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2010). To err is human: Building a safer health system. Washington, D.C: National Academy Press.
Lindenauer, P. K., Remus, D., Roman, S., Rothberg, M. B., Benjamin, E. M., Ma, A., & Bratzler, D. W. (2009). Public Reporting and Pay for Performance in Hospital Quality Improvement. New England Journal of Medicine, 356(5), 486-496.
