Hospitals, physicians, laboratories and others have until January 1, 2009, to provide comments on the proposal by the Centers for Medicare and Medicaid (CMS) on three National Coverage Determinations about preventable surgical errors, or “never events.”

Dark Daily readers know that, beginning October 1, CMS stopped paying hospitals for care or services associated with a list of eight “never events.” Other insurers, including Blue Cross and Blue Shield Association, Aetna, Cigna Corp and Wellpoint, have followed the CMS lead, implementing similar nonpayment policies for medical errors.

A never event is the industry term for a serious preventable medical incident occurring while the patient is under the care of a medical provider. The National Quality Forum (NQF) has developed a list of 28 never events, ranging from surgical and other procedural errors to sending an infant home with the wrong parents.

CMS is proposing to add these three categories of errors to its “no pay” list:

  • Wrong surgical or other invasive procedures performed on a patient
  • Surgical or other invasive procedures performed on the wrong body part; and,
  • Surgical or other invasive procedures performed on the wrong patient.

The CMS proposal to expand the number of “never events” on the no pay list is not without controversy. So far, the American Medical Association (AMA) and AHA have voiced disagreement with the proposal. The AMA opposes CMS using its National Coverage Determination process, which dictates procedures Medicare will or will not pay for, to fight surgical errors. Instead, the AMA suggests that the agency “develop a clear payment policy outlining the circumstances under which surgery would not be payable by Medicare.” The AHA also wants CMS to provide a clear definition of what costs or services would not be covered, but also wants the agency to describe how it would assign accountability for an error.

Meanwhile, there is support for the CMS “never event” policy from other sectors of healthcare. Researchers determined that, since CMS announced implementation of the first “never event” policy for eight conditions in August 2007, 23 state hospital associations had adopted policies forbidding or discouraging billing for serious preventable medical errors.

Large insurance companies quickly responded to the CMS announcement on “never events” by instituting their own no-pay policies for “never events. Aetna was first to publicize its policy. WellPoint and CIGNA soon announced similar policies.

Hospital laboratories are already experiencing the impact of the first round of the CMS “never event” policy that took effect on October 1, 2008. Among the eight conditions were nosocomial infections and administering incompatible blood products to a patient. In both cases, laboratory test services play a key role in providing clinicians with information to properly diagnose the patient and chose the appropriate course of treatment.

Related Information:
CMS Proposes Three National Coverage Determinations to Protect Patients from Preventable Surgical Errors

What Are Never Events and Why Do They Matter?