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Learn About Medicare's Never Events Policy

There's More To It Than Just Patient Safety

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Updated November 27, 2011

Medicare's new never events policy

Medicare's new never events policy

Photo: dscz / iStockphoto.com

See update for 2012 below.

Whether or not you are a Medicare beneficiary, a policy that first went into effect in 2008 will affect you. The new policy addresses "never events" that crop up during a hospital stay. Once the policy took effect, Medicare stopped paying for some of the problems that resulted from a patient's hospitalization.

The never events included on Medicare's list are problems like wrong-site surgeries, transfusion with the wrong blood type, pressure ulcers (bedsores), falls or trauma, and nosocomial infections (hospital-acquired infections) associated with surgeries or catheters. The eight are derived from a master list of 28 never events, so-named, of course, because they should never happen to any patient.

Further, should a never event take place, Medicare states that the patient may not be billed for the additional care needed to address the never event. All that means that, yes, the hospital will be required to cover any additional expenses that emanate from the additional problems a patient has suffered.

Immediately, there are a number of ways this new Medicare never event policy will affect us:

  • Medicare states its number one reason for the new policy is to improve safety and value for patients. Certainly, hospitals will need to begin looking at safer practices to make sure patients don't suffer from these problems, if for no other reason than to reduce the hospital's expense.

  • Health insurers often follow Medicare's lead, and many are poised to implement the same policy. Across the country, those insurers are notifying hospitals that they will not pay for hospital mistakes, and in many cases their lists of mistakes are even more comprehensive. That means those health insurance companies will be saving the expense of further illness on the part of their insurance customers. However, while we would hope to see premiums be lowered, it's probably too much to expect lowered costs to be passed on to customers.

  • There should be a huge impact on Medicare's budget. In 2007, those eight never events alone accounted for $22 billion in expenses. As taxpayers, we should be pleased to see these efforts not only on behalf of our safety as patients, but on our wallets, too.

  • At least 20 states are considering the same policy for Medicaid patients. About a dozen states have already implemented some sort of no-pay-for-never-events policy.

Is It Really All About Patient Safety?

Many patient advocates and patients are cheering loudly! Certainly this policy will make hospital patients safer. And why shouldn't the hospital be required to own up to its employees' mistakes and pay those costs themselves? We'll be saving money, too. What a great idea!

Not so fast. A word of caution is required, because it's not so simple as it sounds.

The first problem is this. Just because a never event has that name, doesn't mean they never happen. Professionals tell us that many of the infections on the list are not really preventable, in particular problems like bedsores or catheter-based infections.

Further, some hospitals struggle to make ends meet as it is. Yes, many will make the effort to eradicate as many of the never events as possible, but they will have to absorb the cost of the problems that do occur. Those who can not handle the problems fiscally may go out of business. Others will raise the prices that can be raised, for other offerings to their patients that Medicare doesn't cover anyway.

Wise patients know, too, that big policy changes often result in unintended consequences. With all the pluses that may result from the new policy, we patients need to be vigilant for problems which could turn out to cost us even more money or even our quality of life.

Here are some problems to watch out for as 2008 Medicare Never Event policy settles in, and as hospitals try to adjust:

  • Hospitals may require patients be tested more thoroughly before admission to show whether they had infections or other problems before they arrived. Additional tests cost extra, of course, and are simply a defense mechanism. There will be no benefit to the patient.

  • An infected or injured patient may be discharged too quickly. If she needs to be readmitted again later, then the hospital will be able to prove, through those additional admission tests, that she arrived with the problem. That means Medicare will end up paying for it anyway, but the patient will have been transported at least twice, while still injured or sick.

  • Patients may be unnecessarily over-medicated with antibiotics to prevent infection, leading to more resistance, leading to more incidents later of infections that cannot be treated.

  • Patients may be billed for additional out-of-pocket "extras" that aren't covered by insurance anyway, and which may not be appropriate.

Should any of these problems happen to you, you'll want to report them to Medicare. It remains to be seen if we will have a way to protect ourselves from them. As time goes on and more is known about this new policy, I will keep this Patient Empowerment site updated.

Update for 2012

With the passage of the Affordable Care Act (healthcare reform), hospitals are now required to survey and report patient experiences and satisfaction. This is another form of transparency needed to keep hospitals focused on quality care for their patients. Learn more about the patient experience and satisfaction surveys, or learn how to fill out a patient satisfaction survey here.

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