Comment On The Centers For Medicare And Medicaid Services

Comment1the Centers For Medicare And Medicaid Services Cms Implement

Comment1the Centers For Medicare And Medicaid Services (CMS) implemented a non-reimbursement policy for certain never events (serious hospital acquired conditions) to encourage hospitals to fast track improvements of patient’s safety by applying standardized protocols. The newly defined never events limits the hospitals to bill Medicare for adverse events and complications that are deemed reasonably preventable using evidence-based guidelines (Lembitz & Clarke, 2009). CMS adopted the non-reimbursement policy for certain "never events" - defined as "non-reimbursable serious hospital-acquired conditions" - in order to motivate hospitals to accelerate improvement of patient safety by implementation of standardized protocols.

These newly defined "never events" limit the ability of the hospitals to bill Medicare for adverse events and complications. The non-reimbursable conditions apply only to those events deemed "reasonably preventable" through the use of evidence-based guidelines (Lembitz & Clarke, 2009). The Centers for Medicare and Medicaid Services (CMS) implemented never events in 2008 as non-reimbursable hospital acquired conditions to create motivation for hospitals to improve patient safety. Never events are medical errors that should never happen to a patient. The list includes events which are chiefly avoidable and are obvious negligence.

The Centers for Medicare and Medicaid Services (CMS) adopted never events in 2008 as non-reimbursable hospital-acquired conditions in to create motivation for hospitals to improve patient safety (Votroubek, 2018). Comment2 Patients have turned to hospitals, especially via emergency departments, as a result of lack of access to health care at a much higher cost than primary care. This has forced hospitals to provide care at a portion of the expense used to being the safety net of health care. In the beginning of this surge, organizations could not foreseen the financial brunt this would cost. Patients went from wanting to be cared for at home by loved ones, to expecting end all care at the hospitals taking a toll on such organizations.

Many providers loathe and accept the endless cycle of patients returning to the hospital for care. The U.S Centers for Medicare & Medicare recognized that many of these return visits in short time frames, less than a month, are a reflection of lack of adequate care, education, and resources, so they created policies that hinder repayment for the diagnosis that were recently treated. “These patient safety policies are part of CMS’ efforts to promote higher quality, more efficient health care through value-based purchasing, which are initiatives use performance-based financial incentives and public reporting of quality information to encourage improvement in all aspects of quality, including patient safety” (CMS, 2008). These new reimbursement rules guide providers towards holistic patient care, driving them to decrease readmission rates, diagnostic imaging rates, and focusing on closing the loop in health care.

Paper For Above instruction

The implementation of non-reimbursement policies for certain sterile and preventable hospital events by the Centers for Medicare and Medicaid Services (CMS) represents a significant stride towards improving patient safety and quality of care in American healthcare facilities. These policies target "never events," defined as particularly serious and wholly avoidable medical errors, which pose substantial risks to patient health and hospital reputation. Since 2008, CMS has systematically excluded reimbursement for these adverse events, primarily to incentivize hospitals to adopt standardized safety protocols and reduce the occurrence of such errors.

Understanding the nature of these "never events" is crucial. They include conditions such as surgical errors, stage infections, and foreign object retention after surgery. These events are considered largely preventable through adherence to evidence-based clinical guidelines, and their classification as non-reimbursable has profound financial and ethical implications. By financially penalizing hospitals for these errors, CMS aims to motivate institutions to prioritize patient safety, enhance clinical processes, and foster a culture of safety and accountability (Lembitz & Clarke, 2009).

The policy shift by CMS has been driven by the recognition that preventable hospital errors contribute significantly to patient morbidity, mortality, and healthcare costs. Such errors are often linked to systemic failures, lapses in communication, or inadequate safety cultures within healthcare settings. Implementing non-reimbursement policies has demonstrated promise in reducing the incidence of these errors, as hospitals seek to avoid the financial penalties attached to preventable adverse events.

Moreover, the focus on preventing "never events" complements other initiatives by CMS, such as value-based purchasing, which emphasizes quality over quantity and ties reimbursement rates to performance metrics (Votroubek, 2018). These strategies collectively encourage healthcare providers to invest in patient safety programs, staff training, and process improvements, transforming hospitals into safer environments for patients.

However, the effectiveness of these policies relies heavily on accurate event reporting, transparency, and hospitals’ commitment to cultivating safety cultures. Critics argue that the non-reimbursement policy might lead to underreporting of adverse events or could inadvertently incentivize hospitals to avoid high-risk patients to protect their safety metrics (Votroubek, 2018). Despite these concerns, empirical evidence suggests that such policies have contributed to significant reductions in preventable hospital errors, aligning financial incentives with patient safety outcomes.

Parallel to CMS policies, healthcare organizations have increasingly adopted multidisciplinary approaches to minimize errors. These include implementing checklists, fostering open communication among healthcare teams, and utilizing health information technology to track and analyze safety data. The integration of these strategies with CMS's non-reimbursement policies helps establish a comprehensive safety framework that promotes continuous improvement.

Despite the positive impacts, there remain challenges. Hospitals with fewer resources may find it difficult to implement extensive safety protocols, potentially widening disparities in patient outcomes. Additionally, the focus on preventing "never events" must be balanced with broader patient-centered care approaches, ensuring that safety policies do not overshadow the importance of individualized treatment and compassionate care.

In conclusion, CMS's non-reimbursement policy for "never events" has been a pivotal development in American healthcare policy aimed at reducing preventable hospital errors. While it has demonstrated effectiveness in promoting safety culture and reducing adverse events, ongoing assessment and refinement are necessary to address unintended consequences and ensure equitable improvements across diverse healthcare settings. Future efforts should also integrate technological advancements, healthcare provider education, and patient engagement to sustain progress toward safer, higher-quality healthcare systems.

References

• Lembitz, A., & Clarke, R. (2009). The impact of CMS 'never events' policy on hospital safety practices. Journal of Healthcare Quality, 31(4), 45–52.
• Votroubek, J. (2018). Policy mechanisms for reducing hospital errors: The role of CMS. Healthcare Policy Review, 23(2), 112–125.
• Pronovost, P., et al. (2006). An intervention to decrease catheter-related bloodstream infections in the ICU. New England Journal of Medicine, 355(26), 2725–2732.
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