Center for Medicare and Medicaid Services (CMS) is an agency of the US federal government that governs Medicare. In addition, CMS collaborates with state governments in governing Medicaid, State Children’s Health Insurance Program (SCHIP), and Health Insurance Portability and Accountability Act (HIPAA).
The HITECH Act tasks CMS with the responsibility of advancing the implementation of IT in the healthcare industry. In addition, the act gives CMS the responsibility of implementing the electronic health record (EHR) and formulation of standards for certification of EHR technology. Implementation of IT in healthcare is one of the major activities of CMS. Therefore, CMS collaborates with the Office of the National Coordinator for Health IT (ONC) to improve the efficiency and relevance of its activities.
Tens of thousands of patients die annually due to preventable medical errors in various American hospitals. According to a report by the Institute of Medicine, avoidable medical errors lead to the death of between 44,000 and 98,000 patients annually (Kohn, Corrigan, & Donaldson, 2008).
In 2002, the Center for Disease Control and Prevention (CDC) estimated that 99,000 patients die due to hospital-acquired diseases (Klevens, et al., 2007). Medical errors lead to approximately 2.3 million extra hospital days and loss of $9.3 billion in excess hospital charges (Zhan & Miller, 2003). These statistics highlight the need for significant improvement in the quality of healthcare delivery in American hospitals.
National Quality Forum (NQF) is one of the first organizations that developed a system that helped in improving healthcare delivery. In 2002, NQF compiled a list of 28 preventable medical conditions. These conditions – never events – were due to the mistakes of medical practitioners.
Therefore, medical practitioners could prevent these events easily. Never events lead to a significant increase in the costs of healthcare provision. CMS has its own list of ‘never events.’ Treatment of preventable conditions makes hospitals receive additional Medicare reimbursements. In response to the Deficit Reduction Act (DRA), CMS formulated a strategy that would prevent hospitals from receiving additional Medicare reimbursements due to the treatment of infections that patients acquire due to hospital stay.
Retention of a foreign object in the patient’s body after surgery is the first never event of CMS. Since this is a preventable event, CMS ensures that hospitals do not receive Medicare reimbursements due to this event. Air embolism is the second never event of CMS. Air embolism is generally non-fatal.
However, it may cause death in some instances. Air embolism may occur if medical practitioners insert air into the patient’s bloodstream. The average cost of air embolism is $67,000 per event (Rowland, 2009). Blood incompatibility is the third never event of CMS. Blood incompatibility occurs when medical practitioners give patients the wrong blood type. The cost of treatment of blood incompatibility is $46,492 per event (Rowland, 2009).
Pressure ulcers are the fourth never event of CMS. Pressure ulcers due to failure of an individual to move and change the area of the skin where the body exerts pressure. The severity of the symptoms of pressure ulcers depends on the duration that an individual exerts pressure on the skin. The symptoms range from reddened skin to loss of skin loss in the area under pressure. The average cost of pressure ulcer is $40,318 per event (Rowland, 2009).
The CMS also classifies falls and trauma related injuries within the hospital setting as a never event. Falls from the hospital bed are the most common event in this category. Catheter-associated urinary tract infections are the sixth never event of CMS. Preventable infections of the urinary tract are some of the most common never events. The average cost of treating catheter-associated urinary tract infections is $40,000 (Rowland, 2009).
Klevens, R.M, Edwards, J.R., Richards, C.L., Horan, T.C., Gaynes, R.P., Pollock, D.A. & Cardo, D.M. (2007). Estimating health care-associated infections and deaths in U.S. hospitals 2002. Public Health Report, 122(2), 160-166.
Kohn, L.T., Corrigan, J.M. & Donaldson, M.S. (2008). To err is human: Building a safer health system. Washington, DC: National Academy Press.
Rowland, H.T. (2009). When never happens: Implications of Medicare’s never-event policy. Marquette Elder’s Advisor, 10(2), 341-382.
Zhan, C. & Miller, M.R. (2003). Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. JAMA, 290(14), 1868-1874.