Site moved to www.healthblawg.com/2007/09/the-latest-on-n.html, redirecting in 1 second...

« P4P spreading like wildfire | Main | David Harlow to speak on Massachusetts universal health care law at Business Lawyers Network »

September 17, 2007

The latest on never events and HAI from CMS, Leapfrog and MA DPH

Everyone's talking about never events, ever since CMS announced its no pay policy for never events last month. But, hey, the CMS reg just implemented a DRA provision that's a couple years old. Not only that, the commercial P4P gang -- e.g., the Leapfrog Group -- already has never events policies in place that go beyond the CMS reg (including apologies and real no-pay rules).

Update 9/25/07:  In an email exchange, the Leapfrog Group's Rachel Weissburg elaborates:  "Leapfrog supports CMS's policy but would like to see it expand to address all 28 Serious Reportable Events. . . .  Leapfrog's Never Events policy . . . also asks hospitals to apologize, report the event, and perform a root cause analysis - critical steps in preventing the event from ever occurring again and also healing the breach of trust between physican/hospital and patient."

Per Managed Care magazine,

The proposed CMS rule change is more limited in scope. If adopted, it will take effect on Oct. 1, 2008, and "will mean that hospitals will not benefit from higher reimbursement for [specific] conditions that were not present at the patient's admission," says CMS spokeswoman Ellen Griffith-Cohen. "We cannot speculate how the private sector will respond."

So why the brouhaha now?  Well, chalk it up to the 800-pound gorilla nature of CMS.  And some hospital folk just get wrapped around the axle of rules like this.  Consider one of the issues on the table in today's Boston Globe article on never events and the no-pay rule: does the rule mean a hospital can't bill for additional surgeries required because of an HAI? Probably.  Does it mean that it has to pay a crosstown rival's bills if a patient with an HAI wants to go elsewhere for followup treatment?  Hmm.

Yes, there are issues to be ironed out, but the core concept is a sound one. 

What I find fascinating here is that in an arena where the regulated community is basically saying that "never" is a mighty tough standard, there has been no discussion of a "substantial compliance" standard, a la OBRA '87.  (If there has been and I've missed it, please clue me in.)

Anyone out there know what I'm talking about?  HCFA -- predecessor to CMS -- and the regulated community took ten years and a bajillion pages of comments to hash out a regulatory scheme designed to implement a zero tolerance statutory scheme governing nursing facility survey and certification. (Echoes of never events.)  In the real world, the statutory standard of absolute "compliance" with Medicare conditions of participation morphed into "substantial compliance."  Maybe, at first blush, that seems incompatible with the concept of never events.  However, it seems to me that some real-world testing of the never event concept needs to happen, including an approach that recognizes that not all never events can be tied to medical errors, just as the lawyer-bashers out there (come, come, you know who you are) would have it that not all bad outcomes can be tied to negligence or malpractice.

While the core concept may be sound, another argument against no-pay for never events is that the dollars at stake are not significant enough to get hospitals' attention.  Lest that be construed as an invitation to add more never events to the list and add penalties to withholding of payment, let me simply suggest that CMS and other payors could get more bang for the buck in other quality initiatives.

HAI is just one of the many never events flagged by both Leapfrog and CMS.  Massachusetts' Department of Public Health has been wrestling with the issue as well, as illustrated by a recent report on HAI in Massachusetts.  Last week, DPH revealed (in a presentation by Paul Dreyer to the Public Health Council) that it would like to expand its hospital surveyor staff and add review of infection control policies, practices and outcomes -- and sharing of best practices across institutions -- to the work of the survey teams.  Like the Leapfrog initiative, this approach is focused on rooting out the bad and nurturing the good.  And it seems that it can be more positive than punitive.

-- David Harlow

TrackBack

TrackBack URL for this entry:
http://www.typepad.com/services/trackback/6a00d83451d52c69e200e54edfa6498833

Listed below are links to weblogs that reference The latest on never events and HAI from CMS, Leapfrog and MA DPH:

» No pay for never events: Massachusetts edition from Trusted.MD Network
This week, Blue Cross Blue Shield of MA and the Commonwealth -- primarily through MassHealth (MA Medicaid) -- announced they would adhere to the Leapfrog no pay for never events policy. According to a news story from about 9 months... [Read More]

Comments

Feed You can follow this conversation by subscribing to the comment feed for this post.

The comments to this entry are closed.