Never events are medical events that are serious, largely preventable, and of concern to both the public and health care providers. The National Quality Forum has identified a list of 28 events such as surgery on the wrong patient, and hospital acquired injuries which are currently identified as never events, but proponents would like to add more events to this list.
The payment policies for never events as set forth by Minnesota, and followed by more and more states recently states that providers will not be reimbursed for procedures and treatments needed as the result of a preventable serious medical event. These events as reported by the CDC account for 2.4 million extra hospital days per year and $9.3 billion dollars in excess charges.
Payers which are adopting these policies include Aetna, CMS, and Blue Cross and Blue Shield, Medicaid (in some states such as VA, and PA). Payers insist that the purpose of these policies is not to save money, but to raise awareness and accountability within hospitals, and help medical establishments prevent serious errors. Increasingly medical “Never Events” are being worked into hospital contracts as they come up for renewal, but not everyone is on board with the adoption of these policies.
Some providers are worried about events which may occur even after they have put significant safe guards in place such as suicide and falls. Others are concerned about payment determination wondering how it will be determined which services are related to “Never Events” and which are not. Patient advocates are also up in arms since if the insurer fails to pay and the hospital disputes the charges the patient may still be responsible. Whatever the outcome of these disputes, “Never Events” policies are catching on and Managed Care Organizations as well as providers should become familiar with these events and the related payment policies going into the future. BHM can help in designing quality improvement programs to decrease the risk of Never Events. “Never Event” payment policies and their recent widespread adoption is something to keep an eye on.
