“Reasonably-Preventable” Conditions

More Payment Reductions from Medicare

[Staff Reporters]

Medicare has implemented its new policy of halting payment to hospitals for the added cost of treating patients who are injured in their care.

Reasonably Preventable

According to the New York Times on October 1, Medicare has put 10 “reasonably preventable” conditions on its initial list, including:

  • patients receiving incompatible blood transfusions.
  • developing infections after certain surgeries.
  • undergoing a second operation to retrieve a sponge left behind from the first.
  • developing serious bed sores.
  • developing urinary tract infections caused by catheters, and;
  • suffering injuries from falls.

Congressional Mandates

The Congressionally mandated Medicare measure is not projected to yield large savings – $21 million a year, compared with $110 billion spent on inpatient care in 2007. But, officials believe that the regulations could apply to several hundred thousand hospital stays of the 12.5 million covered annually by Medicare, while the policy will also prevent hospitals from billing patients directly for costs generated by medical errors.


Over the last year, four states Medicaid programs have announced that they will not pay for as many as 28 “never events,” joining some of the country’s largest commercial insurers, including WellPoint, Aetna, Cigna and Blue Cross Blue Shield plans in seven states.

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 Product Details 

10 Responses

  1. New Book Review

    In the just released book, “The Best Practice,” Charles Kenney chronicles the long march toward a culture within American health care that demands continuous quality improvement [CQI].

    Recall, it was twenty years ago – “today” – that it was almost heretical to question the quality of American health care. The common refrain being that it was unarguably the best in the world.

    Decades of work by Berwick and others, however, have dispelled that myth, and the underlying belief that medical errors and hospital acquired infections are simply an artifact of the business. These quality champions deem it unacceptable that as many as 98,000 Americans die annually from preventable medical errors, and that most Americans receive the recommended care only half the time.

    They’ve spent years building their case, and in turn created a social movement around their cause. And, the case deserves a read!



  2. Kathy,

    Colorado Governor Bill Ritter issued an executive order last week directing the Colorado Department of Health Care Policy and Financing to craft new safety guidelines, including the denial of payment for avoidable medical errors. The executive order directs the department to:

    • Implement a policy to deny or reduce payments for inpatient hospital Medicaid claims for procedures that involve avoidable medical errors known as serious reportable errors, or never- events

    • Work with other health organizations to help create a patient safety organization. The organization will promote quality improvement, patient wellness and patient safety by analyzing serious reportable events and identifying the causes of such events.

    Ritter praised the Colorado Hospital Association and consumer advocates for agreeing to collaborate with the department on new patient-safety policies.




  3. Hello all,

    A new Joint Commission Sentinel Event Alert urges healthcare leaders to boost their efforts to prevent medical errors by taking the zero-defect approach used in other high-risk industries such as aviation and nuclear energy.

    Well, duh!


    Thanks for stating the obvious – Mark R. Chassin, MD.


  4. Wrong-Patient, Wrong-Site Procedures Persist Despite Safety Protocol

    Performing surgery on the wrong body part — or, worse yet, the wrong patient — is the kind of mistake physicians agree should never happen. A series of reports from hospitals documenting how these devastating errors slip through the cracks prompted the Joint Commission in 2004 to mandate a three-step protocol. It required physicians and other health professionals to perform a pre-procedure verification process, mark the correct site for the procedure and conduct a “timeout” discussion as a final check before the procedure begins.

    Yet new evidence shows the commission’s “universal protocol” has not stopped wrong procedures. In fact, the number of wrong-patient and wrong-site procedure reports rose, according to a study of more than 27,370 adverse events self-reported by Colorado physicians and published in the October Archives of Surgery. The study found that 132 wrong-patient and wrong-site procedures were voluntarily reported to the Colorado Physician Insurance Co. from 2002 to 2008, with peak annual numbers of reports for both categories occurring after the commission’s protocol was required.

    Source: Kevin B. O’Reilly, AMMews [11/1/10]


  5. Surgery error leads doctor to public mea culpa


    Will admitting a botched operation in a major medical journal stop future mistakes? You decide.



  6. Joint Commission Targets Wrong-Site Surgery

    The Joint Commission has unveiled a list of potential causes of wrong-site surgery as well as customized solutions that organizations can use to prevent such events. The list is a project of the Center for Transforming Healthcare, a collaborative quality-improvement arm of the Oakbrook Terrace, IL-based accreditation organization.

    National rates of wrong-site surgeries—which include wrong procedure, wrong side and wrong patient—can reach as high as 40 incidences a week, according to a Joint Commission news release. “While wrong-site surgery is not an everyday occurrence, all facilities and physicians who perform invasive procedures are at some degree of risk,” Dr. Mark Chassin, president of the Joint Commission, said in the release.

    Source: Maureen McKinney, Modern Healthcare, [6/29/11]


  7. A System for Patients and Families to Report Errors

    A new pilot program proposed by the Agency for Healthcare Research and Quality, part of the US Department of Health & Human Services, would supplement safety reports now forwarded by providers, including doctors and hospitals, with those from patients and their relatives.

    In the proposed reporting system, these patients and family members “would report medical errors and near misses through a Web site and in telephone interviews.”

    As an example, for each incident, the government would seek to learn the basic facts, including details of the event, whether there was harm and what type, and whether the patient reported the incident and to whom.




    After a cautious and rigorous analysis of national malpractice claims, Johns Hopkins patient safety researchers estimate that a surgeon in the United States leaves a foreign object such as a sponge or a towel inside a patient’s body after an operation 39 times a week, performs the wrong procedure on a patient 20 times a week and operates on the wrong body site 20 times a week.


    The researchers, reporting online in the journal Surgery, say they estimate that 80,000 of these so-called “never events” occurred in American hospitals between 1990 and 2010 – and believe their estimates are likely on the low side.

    Dr. David Edward Marcinko MBA


  9. Infection Control and “Never Events”
    [Series Part I of IV: An Overview of Infection Control and Patient Safety in an Era of “Never Events”]

    The four part HC Topics Series: Infection Control and Patient Safety in an Era of “Never Events,” examines the history and development of the current patient safety and infection control environments within the context of current regulations regarding mandatory public reporting and the reimbursement impact of never events.

    Click to access INFECTION.pdf

    Part I reviews the history of infection control in healthcare and an overview of the current patient safety environment.

    Robert James Cimasi MSHA AVA ASA CMP™
    via Ann Miller RN MHA


  10. Joint Commission Puts Never Events in the Spotlight Again

    Thousands of doctors and other members of a surgery team are still leaving towels, sponges and other foreign items inside of patients every year, costing lives and money.


    The Joint Commission offered advice to avoid such situations in a Sentinel Event Alert last week.

    Dr. David Edward Marcinko MBA



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