Medicare adopts “never event” policy

by Walter Olson on October 3, 2008

We’ve already aired much dissent from the medical profession about whether or not top-notch hospital care can in fact prevent all instances of patient falls, decubitus pressure ulcers (bedsores), hypoglycemia, deep vein thrombosis, delirium, suicide attempts, c. difficile infection, or iatrogenic pneumothorax. Nonetheless, Medicare has adopted its proposal to deny hospitals reimbursement for the cost of treating such events and complications, with likely consequences both for hospital behavior (refusal to admit some patients at high risk of never events), for private insurer behavior and for the climate of medical malpractice litigation. (Kevin Sack, “Medicare Won’t Pay for Medical Errors”, New York Times, Sept. 30). White Coat Rants, who has blogged extensively on the issue in past months, has some predictions (Oct. 1) of things we can now expect to see more of: more patient transfers between hospitals (since Medicare will not punish the second hospital for the first’s “never event”; underdiagnosis of certain conditions and overdiagnosis of others; and, more remotely but no less alarmingly, pressure on some families to serve as ultimate bearers of risk for supposed never events affecting the frailest and most elderly:

Say hello to the Advance Beneficiary Notices. Medicare won’t cover preventative care, so you are going to have to pay for it out of your pocket. If you’re prone to falls or bedsores, you’ll have to pay for a personal nurse to wait on you hand and foot so you don’t develop these never events. If you don’t pay for a personal nurse 24 hours around the clock to keep a never event from happening, you’re personally responsible for paying the costs of treatment if the “never events” occur. You had the opportunity to prevent the events but you were just too cheap to pay for it. I think that ABNs are less likely to catch on, but eventually I think they will become commonplace.

{ 5 comments }

1 Petra 10.03.08 at 10:09 am

It’s just back door rationing. As doctors refuse to treat risky patients they’ll just die, saving money; and when enough people complain the policy will change (or not).

2 Soronel Haetir 10.03.08 at 11:48 am

I would have thought that the hospital-Medicare agreement would have terms excluding such a solution.

3 Soronel Haetir 10.03.08 at 11:52 am

Especially given that one of the major points of Medicare is that the provider can not go after the patient for charges that Medicare does not approve.

I can fully see the other ramifications, rationing, transfers etc though.

4 rxc 10.03.08 at 12:47 pm

This is the medical equivalent of the “mark to market” rule that is causing the current financial meltdown – a rule passed by a Congress that is determined to ensure that something “will NEVER happen again”, because something that is CERTAIN to happen again in the future, got blown all out-of-proportion by the chattering classes. For an engineer, it is a classic example of setting up a system in such a way that is is sure to fail in the future, catastophically(sp?), as soon as the appropriate trigger is indentified and set in motion.

Let’s all give a cheer to our politicians, and the people who swarm around them, and live off of them….

5 OBQuiet 10.03.08 at 5:02 pm

I don’t understand what everyone is complaining about. This is the best thing to happen in Medicine in the last 1000 years!

All we have to do is get Medicare to add Breast Cancer, Heart Attacks and Asthma to that never list of theirs. Think of all the people this will CURE!

We have to start small since we don’t want to put every doctor and hospital worker out of business at once by eliminating all illnesses at the same time. We have to allow time for these workers to be reabsorbed into the workforce as Lawyers, Politician, Bureaucrats and other highly productive types. But we are now within a single generation of DEFINING sickness out of existence!

Can’t you see the advantages of eliminating an entire class of worker that only exists because of others misery? Or are you pro-suffering?

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