The 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).
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.