Regarding the article CMS makes never event nonpayment rules official:
The nonpayment rules by the CMS represent a major detour on the road to enlightened and equitable payment for complex patient care. While all would agree that retained sponges and wrong-site surgery are events that should not occur in the course of quality care and that these costs should be borne by those providing the care, infectious complications and even decubitus ulcers do not meet this level of consideration as being never events. The medical literature is replete with studies that have associated specific co-morbidities of the patient with infectious complications in surgery, and these complications do occur when all current preventive measures and all current technology have been correctly applied.
A far more equitable position is for the CMS to adopt a prospective warranty payment strategy rather than rewarding complicated care with larger payments, or now selectively denying payments for events that they alone believe will never occur when quality care is provided. An actuarial cost that is risk-adjusted to the patients co-morbid profile can be calculated that is indexed to the quality performing hospitals in the CMS database. The warranty prospectively covers all complications so that additional payments are not made for complication events. Hospitals that have quality outcomes and appropriate economic stewardship can have improved margins with such a design, while suboptimal performance including the true never events will result in economic punishment and hopefully renewed incentives to improve quality and efficiency.
Acting CMS Administrator Kerry Weems has said that these new payment policies have the potential to reduce adverse events and costs, but there is no evidence to support that claim. I would offer the counter claim that denial of payment for infectious complications will potentially be translated into perceived high-risk patients being denied access to care. Also, this policy will result in an increased economic burden on safety net facilities that have higher-risk patients. With current CMS payments being viewed as discounted to current hospital costs in many areas of the country, Medicare patients may find receptive hospitals and physicians much more difficult to identify in the wake of these new payment rules.
Donald E. Fry, M.D.Michael Pine and AssociatesChicago
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