Fwd: CMS NEWS: CMS PROPOSES THREE NATIONAL COVERAGE DETERMINATIONS TO PROTECT PATIENTS FROM PREVENTABLE SURGICAL ERRORS

[Guest guest]

Department of Health & Human

Services

Centers for Medicare & Medicaid Services

Room 352-G

200 Independence Avenue, SW

Washington, DC 20201

Office of Media Affairs

MEDICARE NEWS

FOR IMMEDIATE

RELEASE

Contact: CMS Office of Media Affairs

December 2,

2008

CMS PROPOSES THREE NATIONAL

COVERAGE DETERMINATIONS TO PROTECT PATIENTS FROM PREVENTABLE SURGICAL

ERRORS

The Centers for Medicare & Medicaid Services (CMS) proposed today

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 following errors, called

Never Events, being focused on by Medicare through the NCDs are

identified in the National Quality Forum’s (NQF’s) list of Serious

Reportable Events:

·

Wrong surgical or other invasive procedures performed on a

patient;

·

Surgical or other invasive procedures performed on the wrong body

part; and

·

Surgical or other invasive procedures performed on the wrong

patient.

“These types of surgical errors can cause serious injury or death to

beneficiaries and result in increased costs to Medicare due to the need

to treat the consequences of the errors,” said CMS Acting Administrator

Kerry Weems. “The proposed national coverage policies for certain

types of surgical errors are important steps for Medicare in working to

reduce or eliminate their occurrence and their associated payments.”

In 2002, prompted in part by the release of the 1999 Institute of

Medicine report titled, “To Err is Human: Building a Safer Health

System,” the 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© 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 (IPPS) final rule for fiscal years

(FY) 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.

In the IPPS FY 2008 final rule, CMS selected eight conditions for the HAC

list, a number of which were among the 28 Never Events listed by the NQF

and include retained foreign object after surgery, air embolism, blood

incompatibility, stage III & IV pressure ulcers, and falls and

traumas such as electric shock and burns. In the IPPS FY 2009 final

rule, CMS added manifestations of poor glycemic control, including

hypoglycemic coma, to the list. Hypoglycemic coma is closely related to

NQF’s listing of death or serious disability associated with

hypoglycemia.

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 health care providers and suppliers involved in the erroneous

surgeries.

CMS will accept comments from the public regarding the proposed coverage

policies until January 1, 2009. Comments should be submitted

separately for each of the NCDs. Following the close of the 30-day

public comment period, CMS will issue final NCDs within 60 days.

NOTE: For more information, including information about how to submit

comments on each of the proposed NCDs, please see:

Wrong body part:

www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=222

Wrong patient:

www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=221

Wrong surgery performed on a patient:

www.cms.hhs.gov/mcd/viewtrackingsheet.asp?id=223

Proposed Decision Memo:

https://www.cms.hhs.gov/mcd/viewdraftdecisionmemo.asp?id=221