The Centers for Medicare & Medicaid Services (CMS) formed its no-pay policy based on the growing work of National Quality Forum (NQF) of “never events.” Meaning, CMS will no longer pay for certain conditions that result from what might be termed poor practice or events that should never have occurred while a patient was under the care of a healthcare professional.
Discuss specific examples of “never events” and their impact in your workplace.
What issues are you considering for your clinical project and why?
Sample Answer
CMS will not reimburse healthcare providers for certain "never events" because they are considered serious, preventable medical errors that should not have happened while a patient was under a professional's care. Examples of never events include surgical errors like performing a procedure on the wrong body part or patient, as well as hospital-acquired conditions like stage 3 or 4 pressure ulcers and catheter-associated urinary tract infections.
Examples of "Never Events" and Their Impact 🏥
The National Quality Forum (NQF), a non-profit organization focused on healthcare quality, developed a comprehensive list of "Serious Reportable Events" that are commonly referred to as "never events." These events are organized into several categories:
Surgical Events: These are some of the most shocking and widely recognized never events. They include wrong-site surgery (operating on the wrong part of the body), wrong-patient surgery (performing a procedure on the wrong person), and retained foreign objects (leaving a surgical instrument, sponge, or other item inside a patient after a procedure).
Product or Device Events: Examples include patient death or serious injury due to using a contaminated drug, device, or biologic, or an intravascular air embolism.
Patient Protection Events: These events involve harm to patients in a controlled setting. Examples include infant discharge to the wrong person, patient elopement (disappearance), or patient suicide/attempted suicide while in a healthcare facility.
Care Management Events: This category includes errors related to the overall care process. Examples are patient death or serious injury from a medication error, stage 3 or 4 pressure ulcers (bedsores) acquired after hospital admission, and catheter-associated urinary tract infections (CAUTIs).
The impact of these events in a healthcare setting is severe and far-reaching. Beyond the devastating physical and psychological harm to patients and their families, never events have significant financial, professional, and systemic consequences. For instance, the CMS no-pay policy means the hospital doesn't get paid for the services related to the event, leading to significant financial losses. Furthermore, these events cause a breakdown in trust between patients and providers, can lead to litigation and professional consequences for staff, and require extensive resources for root cause analysis and corrective action.
Clinical Project Consideration: Preventing CAUTIs 📈
A strong clinical project would focus on reducing the incidence of catheter-associated urinary tract infections (CAUTIs). This is a relevant issue for several reasons:
Prevalence: CAUTIs are among the most common healthcare-associated infections. They prolong hospital stays, increase healthcare costs, and are a leading cause of preventable patient harm.
Preventability: The majority of CAUTIs are considered preventable through evidence-based interventions. The Agency for Healthcare Research and Quality (AHRQ) and the Centers for Disease Control and Prevention (CDC) have published extensive guidelines on best practices, such as daily assessment of the need for a catheter and proper insertion and maintenance techniques.
CMS and "Never Events": As a recognized "never event," CAUTIs directly relate to the CMS no-pay policy. By reducing CAUTIs, a healthcare facility can improve patient outcomes and avoid financial penalties. The project would address a critical quality and financial concern.