evidence-based guidelines.
4-CMS no longer reimburses health care providers for services that are required to treat certain complications of care. The complications of care have been nick-named “never events” because according to CMS, these events should never happen and are “reasonably preventable by following evidence-based guidelines.” Examples of these never-events include, stage III and IV pressure ulcers, PE or DVTs after certain surgeries, injuries resulting from falls while in-patient, retention of foreign object after surgery, surgery on the wrong body part, surgical site infections after certain surgeries, transfusion of the wrong blood type, and UTI resulting from a catheter.
Some of these events are reasonable. There is simply no excuse to operate on the wrong body part and if a physician makes the mistake of leaving a foreign object in someone after surgery, it is reasonable to not pay them for another surgery to remove it. However, some of these events are going to happen even if every precaution has been taken to prevent these events. DVTs and PEs are still possible even when someone is on heparin or lovenox. Regardless of exactly “how” preventable these conditions are, this change by CMS will certainly cause providers in in patient facilities to be more attentive in their care and prevention of these conditions. Because CMS specifically mentions that these events are preventable by evidence-based guidelines, in patient care models are focusing even more on these guidelines and basing their care off of them. For example, most hospitals now have protocols to prevents CAUTIs, such as requirements to perform and document catheter care, and algorithms for early removal of catheters, and prevention of unnecessary insertion of catheters in the first place.
Reference:
O’Rourke, P. T., & Hershey, K. M. (2018, September 14). Never-Event Implications. Retrieved from https://www.the-hospitalist.org/hospitalist/article/124081/never-event-implications
