“Never Events” Study and Changes In Their Reimbursement

Never Events are incidents which should never occur in a medical practice, incidents which are absolutely inexcusable.  As of October 1, 2008, Medicare (CMS) and other carriers no longer reimburse  for Never Events.  The facilities and practitioners themselves will be held accountable and responsible, and must still provide care for patients that suffer a Never Event.

Twenty-eight possibilities have been identified as official Never Events, but some of them continue to be as seldom as they all should be.  Amongst those twenty-eight, four of them account for 1/6th of the cost of all malpractice claims, according to Aon Corp. and the American Society for Healthcare Risk Management (ASHRM), both out of Chicago.  Those four are: Hospital-acquired infections, Hospital-acquired Injuries, Objects left in the patient’s body duringsurgery, and Pressure ulcers.  Also high on the list is patient elopement or wandering.

Recent research demonstrates that Never Events are occurring at an alarming rate, according to Greg Larcher of Aon Global Risk Consulting.  “The increased awareness surrounding these nonreimbursable conditions may cause a rise in the frequency of related hospital professional liability claims, not to mention other hospital-acquired conditions not currently addressed by CMS regulations,” Greg Larcher says, explaining that their study is the first time Never Events have been examined in this way.

Their study also concluded that, while liability claims have remained stable overall during the past four years, “the not-for-profit segment of the database reflected an increase in claims for the second year.”

More than 100 health care organizations representing over 1,200 facilities, fromcommunity hospitals to multistate publicly traded health care systems were included in the study.  Their loss and exposure data includes 77,705 claims representing $9.3 billion of incurred losses.  This comes to an average of just under $120,000 per loss, which will now have to be absorbed by the health care providers themselves, in many cases.

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