The Centers for Medicare & Medicaid Services (CMS) has 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 errors, called Never Events, addressed by the NCDs include a wrong surgical or other invasive procedure performed on a patient, a surgical or other invasive procedure performed on the wrong body part, and a surgical or other invasive procedure performed on the wrong patient.
In 2002, the National Quality Forum (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 final rule for fiscal years 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.
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 healthcare providers and suppliers involved in the erroneous surgeries.
CMS will accept comments from the public regarding the proposed coverage policies until January 1, 2009. Get more information.
