What’s New in the Patient Safety World


September 2008

CMS’s Final Rule on Non-Payment for “Never Events”





CMS has finalized its list of “never events” for which there will be no additional payments beginning in October 2008. The final rule was published in the August 19, 2008 edition of the Federal Register.



We previously discussed the upcoming changes in our August 21, 2007 Patient Safety Tip of the Week “Costly Complications About To Become Costlier” and January 22, 2008 Patient Safety Tip of the Week “More on the Cost of Complications” and April 22, 2008 Patient Safety Tip of the Week “CMS Expanding List of No-Pay Hospital-Acquired Conditions”. In the latter column we had speculated that not all of the proposed “never events” would make the final list. The final list contains even fewer than we had anticipated.



The first eight hospital-acquired conditions (HAC’s) were:

·        Objects inadvertently left in after surgery

·        Air embolism

·        Blood incompatibility

·        Catheter-associated urinary tract infection

·        Pressure ulcer (decubitus ulcer)

·        Vascular catheter associated infection

·        Surgical site infection- Mediastinitis after coronary artery bypass graft surgery

·        Certain types of falls and trauma

 Of the nine newly proposed changes, only the following made the final list:



CMS’s action thus brings to 11 the number of never events for which it will not make additional payments beginning next month. The final rule also contains a list of other “never events” which will be considered for addition to the list in future years.



CMS has also contacted state Medicaid directors and provided information about how states can adopt the same never events practices. The letter specifically encourages states to adopt the same nonpayment policies outlined in the final rule. Many states already have developed their own plans to eliminate payment for some never events. Some, such as New York, have developed even more extensive lists of events that will no longer be paid for. Private insurers are often following suit as well.



It thus behooves all organizations to ensure they have appropriate patient safety/quality improvement programs in place to minimize the risk of these complications. CFO’s have traditionally focused much more on the revenue side of the balance sheet than the cost avoidance side. Justifying patient safety initiatives to CFO’s should no longer be difficult when you put together a spreadsheet with the number of occurrences of the above events at your facility. And the list will grow in future years.



Update: See also our December 2008 What’s New in the Patient Safety World column “CMS Plans to Stop Payment for Wrong-Site Surgery”.














Patient Safety Tip of the Week Archive


What’s New in the Patient Safety World Archive