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News
CMS Proposes Three National Coverage Determinations on Surgical
Error Prevention
December 03, 2008
by Barbara Kram, Editor - DOTmed News
The Centers for Medicare & Medicaid Services (CMS) proposed
three national coverage determinations (NCDs) to establish uniform
national policies that will prevent Medicare from paying for certain
serious, preventable errors in medical care. The following errors,
called Never Events, being focused on by Medicare through the NCDs
are identified in the National Quality Forum's (NQF's) list of Serious
Reportable Events:
• Wrong surgical or other invasive procedures performed on
a patient;
• Surgical or other invasive procedures performed on the
wrong body part; and
• Surgical or other invasive procedures performed on the
wrong patient.
"These types of surgical errors can cause serious injury or
death to beneficiaries and result in increased costs to Medicare
due to the need to treat the consequences of the errors," said
CMS Acting Administrator Kerry Weems. "The proposed national
coverage policies for certain types of surgical errors are important
steps for Medicare in working to reduce or eliminate their occurrence
and their associated payments."
In 2002, prompted in part by the release of the 1999 Institute of
Medicine report titled, "To Err is Human: Building a Safer
Health System," the NQF created a list of 27 Never Events,
which was expanded to 28 events in 2006.
As part of the ongoing implementation of Section 5001(c) of the
Deficit Reduction Act (DRA) of 2005, CMS has addressed some of the
NQF Never Events through the Hospital-Acquired Conditions (HACs)
provisions in the Inpatient Prospective Payment System (IPPS) final
rule for fiscal years (FY) 2008 and 2009. For discharges occurring
on or after October 1, 2008, Medicare will no longer pay a hospital
at a higher rate for an inpatient hospital stay if the sole reason
for the enhanced payment is one of the selected HACs, and the condition
was acquired during the hospital stay. CMS is exploring how to adapt
this policy to its other payment systems.
In the IPPS FY 2008 final rule, CMS selected eight conditions for
the HAC list, a number of which were among the 28 Never Events listed
by the NQF and include retained foreign object after surgery, air
embolism, blood incompatibility, stage III & IV pressure ulcers,
and falls and traumas such as electric shock and burns. In the IPPS
FY 2009 final rule, CMS added manifestations of poor glycemic control,
including hypoglycemic coma, to the list. Hypoglycemic coma is closely
related to NQF's listing of death or serious disability associated
with hypoglycemia.
CMS determined that not all conditions included on the NQF list
of Never Events can be adequately addressed by the HAC payment provision
and therefore determined that the NCD process was appropriate to
address coverage for the three types of surgical errors cited above.
Unlike the HAC provisions, which affect only payments to hospitals
for inpatient stays, the final NCDs could affect payment to hospitals,
physicians, and any other health care providers and suppliers involved
in the erroneous surgeries.
CMS will accept comments from the public regarding the proposed
coverage policies until January 1, 2009. Comments should be submitted
separately for each of the NCDs. Following the close of the 30-day
public comment period, CMS will issue final NCDs within 60 days.
NOTE: For more information, including information about how
to submit comments on each of the proposed NCDs, please see:
- Wrong body part: www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=222
- Wrong patient: www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=221
- Wrong surgery performed on a patient: www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=223
- Proposed Decision Memo: https://www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?id=221
Source: http://www.dotmed.com/news/story/7584
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Sheldon J. Schlesinger, P.A. represents clients throughout
the state of Florida including the cities of Boca Raton, Boynton
Beach, Carol City, Cooper City, Coral Gables, Coral Springs, Davie,
Deerfield Beach, Delray Beach, Fort Lauderdale, Hialeah, Hollywood,
Jupiter, Lake Worth, Miramar, Miami, Oakland Park, Palm Beach, Palm
Beach Gardens, Palm Springs, Pompano Beach, and Rivera Beach
Broward County • Miami-Dade County • Palm Beach
County
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