"Never Events" and HACs - You Break It, You Buy It

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Clinical PI

Heather Vass
Specialist, Knowledge Transfer
Premier, Inc.

Hospital-acquired conditions are referred to many ways - commonly as never events. Never events are serious, preventable events that happen during a patients encounter with the hospital. Starting Oct. 1, 2008, Medicare wont pay for 8 never events, and promise of additional events will change the horizon of hospital-based reimbursement.

Medicare's list of never events will change the reimbursement methodologies used in the inpatient hospital setting. This presentation aims to give the audience an introduction to the never events and why they were created. Details will be presented on each of the never events (8 at the moment and to include additional identified for FY09) along with strategies to employ to combat never events from happening in the hospital. Never events have serious implications on reimbursement. Using common tools found in DMAIC and Lean, the audience can take away tools to implement changes.

Medicare's IPPS encourages hospitals to treat patients efficiently. The inpatient ruling has further defined these never events as being 1 high cost or high volume, or both, 2 result in the assignment of a case to a DRG that has a higher payment when present as a secondary diagnosis, and 3 could reasonably have been prevented through the application of evidence based guidelines. The entire focus of the never events is to put emphasis on paying for value-based service, not just a patient encounter. Value is translated into quality, safe, effective, efficient, and patient-centered care.