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CMS “Never Events”: The double-edged sword

Thesis Statement:

Despite efforts of upholding safety and promoting improvement of quality patient and health care, the CMS “Never” events has created a pool of complexities for health providers. Firstly, it has not considered the unpreventable and unforeseeable nature of certain health conditions which are at inherent risks of hospital admissions; and, secondly, it has evaluated health care providers as reflections of “increased malpractice actions” without recognizing that the events that they have regarded as events that should never happen, could and actually do happen, regardless of precautionary measures exercised by providers. Thus, it is argued that CMS has created a list which lacks solid grounds for establishment; thus, these events must be subjected to further review, such that health care providers are treated fairly under provisions of CMS policies.

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I. Background: A review of the “To Err is Human Report”

Topic Sentence: Attention towards unchartered medical errors during the past decades has been raised through the 1999 “To Err is Human Report”, in which it has sparked interests and arguments across concerned parties including the government, health care systems and providers, physicians, and patients.

  • A detailed presentation of the contents of the report, with specific attention drawn towards the argument of promoting a better health care system for America through identification of negative impacts of medical errors.

II. CMS Response

Topic Sentence:  In response to rising incidents of medical error deaths, Centers for Medicare & Medicaid Services (CMS) announced in 2007 that it will no longer consider payment for the extra costs of giving treatments to avertable errors, infections and injuries occurring in hospitals

  • Identification of 8 reasonably preventable events (i.e. “Never Events”) for which Medicare will not reimburse.

Topic Sentence: CMS identifies eight conditions that they labeled as “Hospital Acquired Condition” which they claim are preventable, “Never Events”, such that in the event that these errors occur, Medicare will refuse to compensate expenses.

  • CMS 2008 policies reflecting 11 Never Events for which Medicare will not reimburse

Topic Sentence: CMS continues to develop its list of Never Events that it refuses to reimburse, thereby highlighting even more assumed medical errors that need to be carefully avoided by health care providers.

III. Processes and parameters in identification of CMS Never Events (General introduction of processes and parameters for CMS, with specific presentation of the steps and the bases for which they were created)

 Topic Sentence:  CMS chose conditions that were easily categorized and defined as opposed to conditions that providers could easily prevent through sufficient safety protocols.

  • CMS methodology for identification of Never Events vs. NQF’s methodology for identification of Serious Reportable Events (Comparative analysis according to parameters, steps, and grounds for establishment of procedures)

Topic Sentence: Never Events list are generated through taxing processes of identification; NQF’s methods, however, differ from that of CMS’s methods, wherein which CMS’s list are somewhat overlapping when compared to NQF’s list.

IV. Argument

…that all events are not avoidable (With specific attention drawn towards studies that have displayed certain cases of non-avoidable conditions that have been branded as medical errors)

Topic Sentence: As compared to NQF’s list of Never Events, CMS’s list does not consist of events that are completely avoidable and that are a result of a medical error.

V. Analysis of the Utilization of the term “never” and its corresponding impacts of provider liability (Overall analysis of the term “never” and its implications)

Topic Sentence:  The use of the term “never” leads one to believe that, in the absence of medical negligence, the event should not have occurred.

  • Creation of a Standard Care

Topic Sentence: CMS’s policies neither founded a standard of care nor supplied a verification of medical negligence.

  • Negligence per se

Topic Sentence: Negligence per se reviews lead to the establishment that CMS has only recognized its “Never Events” list in order to cut costs concerning Medicare reimbursements and not to guard the security of the public; and that in fact, CMS identification on non-reimbursable events are neither statutes nor ordinances covered by the law.

  • Discussion of Cases

Topic Sentence: Due to many holes identified within the CMS policy, various cases have been raised which highlights the failures of CMS’s “so-called” efforts to protect public safety.

  • Argument

Topic Sentence:  The existence of a “never event” is not automatic negligence per se or, constitutes what is called res ipsa loquitur.

VII. Conclusion

  • Discussion of the unintended results of these regulations (overall evaluation of impacts on health care providers: struggles and difficulties)
  • Increased Litigation

Topic Sentence: CMS never events list increases risks of litigation, providing supplementary motivations for patients to convey legal actions in opposition to a hospital or health care provider.

  • Practice of defensive medicine

Topic Sentence: The CMS list of never events threatens to increase the practice of defensive medicine, in which measures are practices not chiefly to guarantee the health of a patient but to guard a physician or even a hospital against likely negligence accountability.


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