The Centers for Medicare and Medicaid services (CMS) established never events as a way of ensuring that there were medical errors that can be prevented (Mattie & Webster, 2008). The establishment of the initiative was a form of cost-cutting in government health expenditure. Initially, the government through CMS reimbursements would compensate the physicians and the in-patients for mistakes or errors accrued during any medical event.
Wrong-site surgery and wrong-patient surgery are never events. Another error that qualifies as a never event is the act of discharging an infant to the wrong person. Others include patient abduction, sexually assault of patients within health facilities, death and injury of patients as a result of wrong medication. The reimbursement of costs associated with the above errors was a waiver policy. On the other hand, apologizing and reporting the incidents to authorities are alternative recommendations.
By the onset of October 2008, the CMS decided to change the rules of the reimbursement policy. This oversaw the reimbursement policy halted for various reasons.
According to the CMS, the existing list of never events exhibit many events. Therefore, there was a need to minimize the events to ensure there is accountability and validity of the existing never events. In this respect, the CMS found out that only a few events could be listed as never events. In fact, CMS survey found that some of the mistakes such as receiving blood that is not properly cross-matched and properly typed are acts of negligence (Mattie & Webster, 2008). Other mistakes that exhibit negligence and ignorance include leaving sponges and surgery equipments behind after surgery (Mattie & Webster, 2008). According to CMS, these errors are manageable with right procedures and should not be part of the CMS reimbursement.
CMS found out that some of the included never events were indeed part of illnesses, and regularly happen within hospital facilities. These include infections within the hospital facilities, and so the patients will indeed pay for the treatment of these ailments. Example of such unavoidable illnesses and injuries within the hospital context include falls by the elderly. Elderly people fall often and get hospitalized for falls. Therefore, the CMS should not reimburse an illness or injury that is going to happen any moment.
CMS insist that some complications or co-morbidities that patients get while in the hospital should not be reimbursed. On this point, CMS used never events such as patient falls, pressure ulcers, incompatible blood, urinary tract and blood infections acquired in hospital and air embolism as some of the complications not to be reimbursed (Bunting, 2010).
The ratification of the CMS reimbursement rule was also to provide guidelines on documentation of clinical procedures. For example, it is important to record patients’ conditions to ensure reimbursement of the qualified never events. Moreover, this promotes quality health care and better judgment among the medical professionals.
In situations where there are dual eligibles, the Medicaid pays for such occurrences. However, Medicaid will only exist as a secondary payer in relation to Medicare (Bunting, 2010). This CMS policy is to ensure that health care provider is still eligible to patient compensation in an improper patient care situation.
In conclusion, the CMS reimbursement rules are to ensure that all states harness their Medicaid payment policies. These policies are to ensure that Medicare payment policy benefits all in-patients through quality health care. Moreover, the government will save a lot of unnecessary costs from avoidable medical situations.
References
Bunting, R., F. (2010). Calculating the frequency of serious reportable adverse events and hospital-acquired conditions. Journal of Healthcare Risk Management, 30(1): 5-22.
Mattie, A., S. & Webster, B., L. (2008). Centers for Medicare and Medicaid Services’ “never events”: An analysis and recommendations to hospitals. Health Care Manager, 27(4): 338-349.