N.Y. Medicaid program to stop reimbursing for preventable errors
As defined by several U.S. quality measurement organizations, never events include surgical errors such as procedures performed on the wrong body part or the wrong patient. In addition to wrong-site surgery and serious medication errors, never events also include complications such as unintentionally leaving a foreign object in a patient or administering incompatible blood. A 1999 study by the Institute of Medicine estimated that as many as 98,000 deaths a year may be attributable to medical errors.
"Patient safety is one of the nation's most pressing health challenges. Many insurers and hospital associations throughout the United States have reported never events voluntarily and adopting policies to heighten awareness about medical errors and to improve efforts to minimize the likelihood of such events,” said Health Commissioner Richard F. Daines, MD.
"Reforming Medicaid's hospital payment system is a key initiative in New York Medicaid,” he added. "Reform isn't solely about balance sheets – quality of care and patient safety are paramount. This policy change will improve the value of Medicaid's payment for hospital patients who receive acute care and provide further incentives for hospitals and clinicians to improve the quality and safety of inpatient care."
Hospitals receiving payment under the N.Y. Medicaid program will be required to provide information on each admission that will designate which complications were present on admission, and which ones occurred during or as a result of hospital care. By working with the hospital and clinical community, this information will help the Medicaid program determine when increased payment for complications will be denied.
The 14 avoidable hospital conditions that the state has identified as non-reimbursable are:
- Surgery performed on the wrong body part;
- Surgery performed on the wrong patient;
- Wrong surgical procedure on a patient;
- Foreign object inadvertently left in patient after surgery;
- Medication error;
- Air embolism;
- Blood incompatibility;
- Patient disability from electric shock;
- Patient disability from use of contaminated drugs;
- Patient disability from wrong function of a device;
- Incidents whereby a line designated for oxygen intended for patient is wrong item or contaminated;
- Patient disability from burns;
- Patient disability from use of restraints or bedrails; and
- Patient disability from failure to identify and treat hyperbilirubinemia (bilirubin in blood) in newborns.
CMS officials in August 2007 announced that effective October 2008, Medicare no longer will reimburse hospitals for the treatment of preventable errors, injuries and infections that occur in the facilities. The eight conditions for which Medicare no longer will reimburse hospitals for treatment include: falls; mediastinitis, an infection that can develop after heart surgery; urinary tract infections that result from improper use of catheters; pressure ulcers; and vascular infections that result from improper use of catheters. In addition, the conditions include three never events: objects left in the body during surgery, air embolisms and blood incompatibility.