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How does Medicare handle “Never Events”?

On Behalf of | Jul 15, 2022 | blog, Medical Malpractice

The Centers for Medicare and Medicaid Services covers many healthcare expenses for customers of Medicare. In 2008, CMS identified specific never-event medical complications and conditions. CMS penalizes medical facilities for certain never events, which are scenarios that should never happen under hospitalized care. The never events policy has been protecting patients of Georgia and the rest of the country since 2013.

Never events and medicare

The original Hospital Acquired Conditions of 2008 covers eight types of medical malpractice. Central line placements causing bloodstream infections and catheters causing urinary tract infections were common scenarios covered by HACs. HACs also cover patients acquiring pressure ulcers or falling while in the hospital. The CMS also includes patients receiving transfusions with the wrong blood type as never events. The policies align with the health insurance industry’s and facility stakeholders’ efforts to decrease medical malpractice.

CMS 2015 study

The study includes 1,381 US hospitals with a focus on four of the HACs. While tracking the frequency, experts saw an 11% reduction in central-line bloodstream infections. There was a 10% reduction in urinary tract infections from catheters. A study of 8.8 million people found 13.4 never-events per 1,000 people, but this has been declining since 2013.

HACs that Medicare tracks

HACs cover a few new never-events as of 2020, such as a foreign object left in a body during surgery. Along with falls, there are burns, dislocations and other injuries in the hospital. Diabetes from coma complications is a never-event. HACs also cover deep vein thrombosis or pulmonary embolism after orthopedic surgeries.

The CMS has its HAC Medicare reimbursement policies apply to any facility seeking payment when treating patients under Medicare. Several types of facilities can seek payment in 2021, such as rehabilitation hospitals and units. Veterans Affairs medical centers and hospitals may seek reimbursement. Medical facilities under CMS include critical care hospitals, long-term care hospitals, children’s hospitals and psychiatric hospitals and units.