Never Events and HAC’s

Effective Oct 1, 2008, the Centers for Medicare & Medicaid Services (CMS) requires all Medicare participating hospitals to disclose all hospital acquired conditions (HAC). In addition to the disclosure requirement, CMS has stated that is will not reimburse hospitals for any of the additional costs brought on by an HAC.

At the extreme end of HAC’s are the so called “Never Events” which should “never happen in a hospital.” If a Never event occurs at a hospital, the hospital will be denied complete reimbursement of that event. Also, hospitals are prohibited from passing charges from HAC’s and Never Events on to the patient.

Because the hospital now is forced to foot the bill for these events, they pose a great liability for the hospital that must be limited. The HAC’s listed in number 8 below are all Never Events, thus hospital’s have sole liability for their costs.

Hospital Acquired Condition (HAC) Definition

HAC’s are defined as preventable conditions that the patient did not have upon entering the hospital, but gained while in custody of the hospital. The list below of HAC’s has been identified by CMS, and any additional costs brought on by these HAC’s such as extra inpatient days spent at a hospital will be denied reimbursement by CMS.

Never Events Definition

A Never Event is a more serious HAC defined by the National Quality Forum (NQF) 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.” The list of Never Events below has been identified by CMS and any reimbursement sought for these events will be denied.

List of Never Events covered under the FY 2009 provision

  1. Object left in patient during surgery
  2. Air embolism
  3. Blood incompatibility
  4. Catheter-associated urinary tract infection
  5. Pressure ulcers
  6. Vascular-catheter-associated infection
  7. Surgical site infection (specifically mediastinitis after coronary artery bypass graft surgery)
  8. Hospital-acquired injury due to external causes (fractures, dislocations, intracranial injury, crushing injury, burns, and other unspecified effects)

The Number 8 never event, Patient Falls, is one which has received much attention over recent years. As noted in the white paper “An Assessment of Falls in Patient Rooms: And Methods of Prevention,” the frequency and severity of falls is of great concern and cost.

Preventing “Patient Fall” Never Events

While fall risk awareness and fall-prevention training can certainly help, the reality is, a nurse cannot do anything to help prevent a fall if they don’t immediately know that the patient is beginning to move in a high-risk manner. For example:

•    Patient is beginning to get out of bed,
•    Patient is beginning to get out of a chair
•    Patient is in urgent need to go to the toilet

Standard nurse call systems and bed fall alert beeper systems often do not accomplish the task of communicating these specific situations to the responsible caregiver in a position to help.

Today, new systems are becoming available, such as Dalcon Alert! which, when combined with fall alert sensors, can get the pending danger to the right caregiver quickly regardless of the caregiver’s location.