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New Categories of Hospital-Acquired Conditions: the Never-Ending Story

by E. Dale Burrus, JD, LLM on June 21st, 2011

Through the 2005 Deficit Reduction Act, Medicare reduced payments to hospitals for Hospital-Acquired Conditions, also known as Never Events. These occurrences in question were recommended by National Quality Forum (NQF) which termed the events, Serious Reportable Events. Private insurers followed Medicare’s lead and stopped reimbursement for some or all of the Never Events. In July of this year, states are required through the Patient Protection and Affordable Care Act to adopt the same rules of no reimbursement for Medicaid.  States can add other types of adverse events to the 26 Never Events adopted by Medicare.

To that point, NQF now has added four new Serious Reportable Events.  They are:

  • Death or serious injury of a neonate associated with labor or delivery in a low-risk pregnancy.
  • Patient death or serious injury resulting from the irretrievable loss of an irreplaceable biological specimen.
  • Patient death or serious injury resulting from failure to follow up or communicate laboratory, pathology, or radiology test results.
  • Death or serious injury of a patient or staff associated with the introduction of a metallic object into the MRI area.

According to NQF, the update has three purposes:

1)  To ensure the continued currency and appropriateness of each event in the list;
2)  To ensure the events remain appropriate for public accountability; and
3)  To provide guidance gained by implementers to those just beginning to report these events, across hospitals and for three newly specified settings of care—office-based practices, ambulatory surgery centers, and skilled nursing facilities.

At present, when many health providers are questioning whether the accepted Never Events are in fact preventable, new categories that may raise even more significant questions are being introduced.

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From → Health Law