CMS Moving to Reduce Disastrous but Preventable
‘Never Events’ in Hospitals
Medicare. Medicaid expect to pay $4.75 billion to
acute care hospitals
Aug. 4, 2008 - The Centers for Medicare & Medicaid
Services (CMS) late last week announced it is taking several actions to
improve the quality of care in hospitals and reduce the number of “never
events” -- preventable medical errors that result in serious
consequences for the patient. Overall, the final rule is estimated to
increase Medicare payments to acute care hospitals by nearly $4.75
billion.
“Never events cause serious injury or death to
beneficiaries and result in unnecessary costs to Medicare and Medicaid
due to the need to treat the consequences of the errors,” said CMS
Acting Administrator Kerry Weems.
“The steps taken today reflect our strong
conviction that these events, in fact, should be prevented, and our
commitment to protecting Medicare and Medicaid patients from them.”
The news release as presented by CMS follows:
A final acute care inpatient prospective payment (IPPS)
rule that went on display Thursday at the Office of the Federal Register
for publication August 19, 2008 updates Medicare payments to hospitals
for fiscal year (FY) 2009 and provides additional incentives for
hospitals to improve the quality of care provided to people with
Medicare.
As part of these quality of care incentives, the
rule includes payment provisions to reduce never events that occur in
hospitals.
In addition to the final rule, CMS sent a letter to
state Medicaid directors providing information about how states can
adopt the same never events practices.
The letter specifically encourages states to adopt
the same non-payment policies outlined in today’s final Medicare rule.
Nearly 20 states already have or are considering methods to eliminate
payment for some never events.
CMS also announced the opening of a process to
develop three National Coverage Determinations (NCDs) that would address
Medicare coverage of certain surgical procedures. Medicare NCDs set
national policy on whether Medicare will cover an item or service and
under what conditions. In the absence of an NCD, coverage decisions are
made by the local contractors that process and pay Medicare claims. The
three types of surgery under consideration are surgery on the wrong body
part, surgery on the wrong patient, and wrong surgery performed on a
patient.
Occurrences of the types of surgeries in the NCDs
announced today have been identified by the National Quality Forum (NQF)
as “Serious Reportable Events,” commonly referred to as “never events.”
Evaluating coverage of these procedures is yet another important step
for Medicare in addressing concerns regarding never events.
CMS today begins the NCD process by commencing a
national coverage analysis (NCA) with a 30-day public comment period.
During the comment period CMS accepts comments from the public regarding
the issues under consideration. A proposed decision memorandum will be
released on or before February 1, 2009, for another round of public
comments and then finalized no later than April 30, 2009.
In 2002, prompted in part by the release of the
1999 Institute of Medicine report titled “To Err is Human: Building a
Safer Health System,” the NQF created a list of 27 Serious Reportable
Events, which was expanded to 28 events in 2006.
The NQF defines these events as errors in medical
care that are clearly identifiable, preventable and serious in their
consequences for patients. The IOM also concluded that medical errors
including those that result in hospital-acquired conditions, may be
responsible for as many as 98,000 deaths annually, at costs of up to $29
billion.
In addition to the administrative actions being
taken, specific legislative proposals were included in the President’s
FY 2009 budget submitted to Congress that would have prohibited Medicare
payment for never events and would have required hospitals to report
never events or receive a reduced annual payment update.
The IPPS rule adds conditions, including one NQF
never event, to the list of conditions that have been determined to be
reasonably preventable through proper care. Beginning last year, as
required by the Deficit Reduction Act of 2005 (DRA), CMS began selecting
hospital-acquired conditions (HACs) that were determined to be
reasonably preventable.
If a condition is not present upon admission, but
is subsequently acquired during the hospital stay, Medicare will no
longer pay the additional cost of the hospitalization. The patient is
not responsible for the additional cost. Rather, the hospital is being
encouraged to prevent an adverse event and improve the reliability of
care it is giving to Medicare patients.
In last year’s final rule, CMS listed eight
preventable conditions for which it would not make additional payments.
In this year’s proposed rule, CMS identified nine potential categories
of conditions, but based on public comments, is finalizing three of
these. The new additional conditions in this year’s final rule include:
● Surgical site infections following certain
elective procedures, including certain orthopedic surgeries, and
bariatric surgery for obesity
● Certain manifestations of poor control of
blood sugar levels
● Deep vein thrombosis or pulmonary embolism
following total knee replacement and hip replacement procedures
The final rule issued today also expands the
Reporting Hospital Quality Data for Annual Payment Update Program. The
Medicare law requires CMS to reduce payments to hospitals that do not
successfully report quality measures adopted under the program by two
percent from the percentage increase that would otherwise apply to their
payment rates.
The quality measures are publicly reported on the
CMS Hospital Compare Web site, a tool that can be used by beneficiaries
in choosing where to receive treatment.Hospitals are currently required
to report 30 quality measures on their claims for Medicare inpatient
services to qualify for a full update to their FY 2009 payment rates.
CMS had discussed 43 new quality measures in the
proposed rule and requested public comment on those measures. After
reviewing public comments on the proposed rule, CMS decided to add only
13 measures.CMS is also finalizing its proposal to retire one pneumonia
measure – oxygenation assessment – effective January 1, 2009.
Therefore, the total number of measures for
reporting in 2009 will be 42. The retirement of a measure reflects
hospitals overall improvement of care for this condition and creates the
opportunity for additional quality measures to be added, thus further
enhancing the opportunity for Medicare to measure care and drive overall
improvement.
The IPPS, which was first implemented in 1983, was
intended to reward hospitals for being efficient by making a single
payment to the hospital based on the average costs of treating a patient
with a particular diagnosis, rather than paying for the actual costs of
each case. However, until the 2005 DRA, Medicare did not have the legal
authority to use its payment system to encourage hospitals to improve
the quality and reliability of care they furnish.
“While it may be some time before we can begin to
assess the real impact of these steps on patient care, we are hearing
from hospitals around the country about efforts they have undertaken in
the past year to improve staff training and other measures to reduce the
incidence of these preventable conditions,” Weems said.
“And other payers, both public and private, are
beginning to adopt similar policies in their payment systems. This is a
win-win situation: better outcomes at less overall cost.”
The final IPPS rule announced today updates payment
policies and rates for more than 3,500 hospitals that are paid under
Medicare’s diagnosis related group (DRG) payment system and is designed
to promote the Administration’s goal of transforming Medicare to a
prudent purchaser of health care services, paying for quality of
services, not just quantity.
The final rule will appear in the August 19, 2008
Federal Register, and will be effective for discharges on or after
October 1, 2008.
>> For more information, at CMS Web site,
click here
>> Additional details about open NCAs are available
on the tracking sheets found on the coverage website,
click here..
>> Instructions for submitting comments may be
found by
clicking here.
>> Hospital reporting of quality measures can be
found on the Hospital Compare Web site,
click here.
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July
4, 2008