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CMS' Never-Never Land

Zero tolerance policy is reducing medical errors, improving care and saving money, government says.

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Never is a long time - an eternity, in fact.

That's how long hospitals will wait before Medicare reimburses them for care necessitated when a patient takes a fall during rehab, or develops serious pressure ulcers, or comes down with a catheter-related infection.

Hospitals now absorb those costs - and have since 2008, when Medicare's no-pay policy kicked in. In 2009, Medicare saved an estimated $21 million this way, according to Ellen Griffith, a spokesperson for the Centers for Medicare and Medicaid Services (CMS).

"Implementing this provision gives hospitals a financial incentive to reduce the frequency of certain conditions that can often be prevented by observing accepted standards of care," Griffith explained. "More importantly, it has improved the quality of care rendered to hospital inpatients."

Medicare calls its list of medical errors for which it no longer reimburses "hospital-acquired conditions" or HACs.

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Preventing DVTs and pulmonary emboli in hospitalized patients.

Some HACs, like giving a patient the wrong blood type, should never happen, while others are only "reasonably preventable" through adherence to evidence-based guidelines, according to Medicare officials.

The term "never event" originated with the Leapfrog Group, a Washington, DC-based not-for-profit representing large purchasers of healthcare founded in 2000 that uses its collective purchasing power to influence government policy.

Leapfrog patterned its list of never events after a list of preventable, adverse events developed by the National Quality Forum, an agency within the U.S. Department of Health and Human Services.

"There has been some attempt recently among providers to water down the concept," said Leapfrog CEO, Leah Binder, MA, MGA. "They say, 'Let's talk about events that should not happen instead of events that should never happen.'

"But some events are so egregious they should never happen, like removing the wrong limb. They are hard to justify," Binder continued. "We still need to strive for the word 'never.' Purchasers are really passionate about this point."

And nurses, she said, are the first line of defense against never events.

Empowering Nurses

"Nurses see the problems of patient safety every single day," Binder said. "Nursing should work closely with purchasers as an ally to improve bedside care and demand transparency because it shines a light on what nurses do. Nursing's priorities should become a hospital's priorities."

In 2007, Vanderbilt University Medical Center, Nashville, TN, launched a major effort to refine its patient safety initiatives - and put nurses at the core of the effort.

For example, Vanderbilt nurses are now empowered to remove urinary catheters when patients meet certain criteria, according to Marilyn Dubree, MSN, RN, executive chief nursing officer. And OR nurses have forcing functions in their documentation to ensure clear and consistent timeouts in surgical suites and patient care areas.

"This is a consensus-driven organization and significant effort goes into agreement on standardized, evidence-based practices, including extensive dialogue between nursing and physicians," Dubree said. "Every level of the organization has an operational medical director who partners with the appropriate nurse leader."

Patient safety is a multidisciplinary effort, Dubree continued. "Perhaps now more than ever, providers and healthcare leaders understand the power and importance of teams working in synergy to deliver accurate, reliable, and consistent care," she said.

"Nurses work extensively with physicians, pharmacists, respiratory therapists, administrators, supply chain colleagues, informatics; the list goes on. Clinical care is complex and impacted by a myriad of individuals and systems."


CMS' Never-Never Land

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These "never events" are great to strive for. However, the patient should not be stuck with the bill for the unreimbursed care if the event does occur, through no fault of their own. My grandmother -who relies on Medicare and Medicaid -developed several DVTs after ortho surgery, and she has been sent a bill for the uncovered charges.

Cheryl July 14, 2010
OH




     

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