CMS Reimbursement Rules for Never Events

Question

Discuss how the CMS reimbursement rules for never events required a shift in the patient care delivery model in inpatient facilities.

Answer

CMS Reimbursement Rules for Never Events

Recent changes made to the Center for Medicare and Medicaid Services (CMS) included the requirement in which the federal payor programs will no longer reimburse for never events (Mattie & Webster, 2008). Under the CMS payment policy, never events refer to medical errors that are identifiable, measurable, and avoidable. The logic behind it is that most of the complications that occur are due to a failure in the policies and procedures of the health care organization in question or a mistake on the part of the personnel. These new rules have required a significant shift in inpatient care in inpatient facilities.

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The new CMS policy has greatly affected the liability risk of any healthcare personnel that is charged with providing inpatient care. This is applicable regardless of whether or not there is the involvement of a federal payor. For this reason, most if not all personnel have started working on making sure that they provide the best care possible in fear of being made liable to any complications. By changing their policy, CMS hoped to reduce the cases of hospital-acquired infections and the like (Mattie & Webster, 2008). In a way, the new policy has achieved its purpose.

It is also worth noting that never events can be categorized into case management, surgical events and medical products and devices, all of which are handled by the health care personnel. By changing the policy, CMS made it clear that the power of improving the quality of health care is in their hands. They have all the tools needed to prevent hospital-acquired infections and other complications. While it is true that some complications are unavoidable, it is also true that most of the negative outcomes can be avoided altogether with the proper kind of care.

Reference

Mattie, A. S., & Webster, B. L. (2008). Centers for Medicare and Medicaid Services'” Never Events”: An Analysis and Recommendations to Hospitals. The Health Care Manager, 27(4), 338-349.

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