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What are Medicare’s “never events”?

On Behalf of | Aug 31, 2022 | Medical Malpractice |

Centers for Medicare & Medicaid Services (CMS), the branch of the Department of Health and Human Services that covers the various healthcare costs for those who receive benefits in Illinois, has a list of what it calls “never events.” It’s a name referring to the conviction that certain things shouldn’t happen to anyone while in the hospital for any reason.

Things that should never happen

One extreme example would be a case of medical malpractice in which a patient wakes up to find the wrong part of their body operated on. But virtually all examples of never events are extreme because that’s what gains them such a condemning classification.

This started in 2008, when the organization called out particular cases of medical errors and malpractice – all situations that would lead to the medical facility in question receiving a penalty. There were a total of eight categories of never events listed in the initial 2008 version of the HAC rules.

Any one of these would result in the CMS paying less money to the healthcare facility in question. Additionally, this policy helped to make it so the patient is no longer expected to pay for any additional care that results from these events.

The main never event categories include:

  • Bloodstream infections
  • UTIs
  • Pressure ulcers
  • Falling
  • Transfusing the incorrect blood type

A controversial policy

HAC policies have been the subject of much controversy in spite of the support from certain states, insurance providers, and stakeholders. It would be hard to prove one way or the other how effective they are, and there have been industry efforts to limit the rules. But the CMS maintains that they are just trying to look out for the patients, and their safety is their number one concern.

In 2013, the policy for never events took on the name Hospital-Acquired Condition (or HAC) Reduction Program, which is a comprehensive guide to the official policy for the never events that CMS has identified. Their research and guidelines continue to change and grow, adapting to the ever-changing needs of the most vulnerable patients.