More “Never Event” Rules Proposed by Federal Health Officials

Federal health officials have proposed adding dangerous blood clots in the leg and eight other conditions to the list of complications that Medicare won't pay to treat if they were acquired at the hospital. Medicare set a new precedent last year by refusing to pay hospitals for treating certain "never events" conditions that occur as a result of hospital error. For example, if a patient was given the wrong blood type, Medicare would not pay the hospital more for treating that complication. Originally, eight conditions were covered under the new rules, which take effect Oct. 1.

The rules proposed this week add other conditions, including:

• Deep vein thrombosis, or a blood clot within the vascular system,

• Ventilator-associated pneumonia, 

• Bloodstream infections with the staph aureus bacteria,

• Legionnaire's disease

Medicare's policy often sets precedent for private insurers, and many of them have already begun to adopt their own never-event policies. The proposed rule would apply to more than 3,500 acute care hospitals. Medicare gives hospitals a single payment based on the average cost of treating a patient with a particular diagnosis. Officials said hospitals cannot try to charge the patient for the costs associated with treating a never event.
Congress in 2006 gave the Centers for Medicare and Medicaid Services the power to prevent Medicare from giving hospitals higher payments for the extra costs of treating a patient when infections and other preventable conditions occur during a hospital stay.