CMS Denying Payments for Many Preventable Errors-August 2008

Mr. Lamb is a freelance pharmacy writer living in Virginia Beach and president of Thorough Cursor, Inc.

The Centers for Medicare & Medicaid Services (CMS) this week published Medicare Part B payment rules that include an expanded list of “Serious Reportable Adverse Events” whose occurrence will result in the denial of reimbursement. The list was first created for the fiscal year 2008 Medicare program, and this year’s list includes a total of 14 preventable medical errors, with 6 being identified as “never events.”

Following the National Quality Forum, CMS defines never events as “errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients, and that indicate a real problem in the safety and credibility of a health care facility.” For fiscal year 2009, CMS identifies never events as:

• Foreign object retained after surgery
• Air embolism
• Blood incompatibility
• Deep vein thrombosis following certain orthopedic surgeries
• Manifestations of poor glycemic control
• Infections following elective surgeries (eg, bariatric surgery)

Acting CMS Director Kerry Weems noted in a press statement that since CMS began withholding reimbursements for the remediation of medical errors, his agency has been “hearing from hospitals around the country about the efforts they have undertaken…to improve staff training and other measures to reduce the incidence of these preventable conditions.”

Infections from improper catheterization and infections following heart surgery also are on the list of problems that are not covered under Medicare. CMS also has specified that health care facilities will have to bear the cost of remedying adverse events caused by medication errors involving the wrong drug, wrong dose, wrong patient, wrong time, wrong rate, wrong preparation, or wrong route of administration. This underscores the importance of hospital pharmacists being part of the health care team and making sure protocols are in place to prevent medical errors from ever reaching the patient.