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National Business Coalition on Health Endorses New CMS 'Never Events' Policy

National initiative launched to support CMS' hospital-acquired conditions
payment reform efforts

WASHINGTON September 29, 2008 Today the National Business Coalition on Health (NBCH) announced its continued support of the Centers for Medicare and Medicaid Services' (CMS) efforts to influence payment reform by no longer paying for specific "Never Events" - serious and costly preventable hospital errors. Effective October 1, Medicare will no longer provide hospital reimbursement for 12 preventable hospital-acquired conditions and errors that occur after admission. In turn, NBCH, a non-profit organization of 60 employer-based health coalitions, representing over 7,000 employers across the United States, launched a national initiative to encourage its coalition members, partner organizations and private purchasers to drive adoption of this non-payment policy in local markets.

"In today's health care environment, private and public policy decisions need to complement one another to drive health system improvement," said Andrew Webber, president and CEO of NBCH. "We need to support improvement in our communities by translating CMS' efforts into payment reform in the private sector that affects all patients, not just Medicare patients. By building on CMS' policy, private purchasers and stakeholders will send a strong and consistent message that hospitals need to avoid preventable medical errors and omissions."

The Agency for Healthcare Research and Quality (AHRQ) estimates that preventable errors [occurring] during or after surgery may cost employers nearly $1.5 billion a year. NBCH, representing health care purchasers committed to cost reductions and quality improvement, realizes the severe impact of preventable medical errors on the overall system and agrees that both public and private purchasers should refrain from paying for such errors.

Many NBCH coalition members have been proponents of payment reform for years. As Regional Roll-Out leaders for The Leapfrog Group, these coalitions are actively involved in hospital performance and public reporting efforts in the local market, including the Leapfrog Hospital Survey. A section of this survey addresses 28 serious preventable errors or "Never Events" as set forth by the National Quality Forum (NQF).

"In 2006, the Midwest Business Group on Health (MBGH) adopted Leapfrog's policy on 'Never Events,' which is a four-step process for hospitals that perform a serious medical error: apologize to the patient, report the event to the required organizations, perform a root-cause analysis, and waive all costs to the patient and payer for the event," said Larry Boress, MBGH president and CEO in Chicago. "As of July 2008, 24 out of 56 hospitals in Illinois participating in the Leapfrog Hospital Survey have signed on to the Leapfrog 'Never Events' policy, and our goal is to have all hospitals follow this path."

Beginning October 1, CMS will no longer provide payment reimbursement to hospitals for 12 clinical diagnosis-related groups (DRGs) as secondary billable diagnosis codes if those conditions were not present upon admission. Six of the approved DRGs are categorized as "Never Events" by the National Quality Forum - preventable surgical, product/device, and criminal events that should never occur in the hospital environment.

In recent months, several private and public purchasers have aligned with CMS' payment reform efforts by adopting non-payment policies regarding hospital-acquired conditions (HACs) and "Never Events." Private health plans such as Aetna, Anthem, several Blue Cross organizations and CIGNA have implemented non-payment policies for their commercial populations. Likewise, the state Medicaid agencies of Massachusetts, New York, and Pennsylvania have followed CMS' lead and adopted similar non-payment policies.

To advance this initiative, NBCH has produced a set of support materials for its coalition members related to non-payment policy adoption. Coalitions can use these materials to initiate stakeholder discussions within the local community to improve quality care and support payment reform. In addition, NBCH will add new hospital-acquired condition content to eValue8, a standardized health plan request for information tool used by coalitions in more than 20 markets across the country, as a long-term goal of the payment reform initiative. The scope of this initiative is supported by sanofi-aventis, a long-term partner of NBCH dedicated to health care system improvement efforts.

About the National Business Coalition on Health
NBCH is a national, non-profit, membership organization of 60 business and health coalitions, representing over 7,000 employers and 34 million employees and their dependents across the United States. NBCH and its members are dedicated to value based purchasing of health care services through the collective action of public and private purchasers. For additional information visit: www.nbch.org.

List of hospital-acquired conditions included in CMS' non-payment policy:
- Foreign Object Retained After Surgery
- Air Embolism
- Blood Incompatibility
- Stage III and IV Pressure Ulcers
- Falls and Trauma
- Catheter-Associated Urinary Tract Infection (UTI)
- Vascular Catheter-Associated Infection
- Surgical Site Infection-Mediastinitis after Coronary Artery Bypass Graft (CABG)
- Surgical Site Infection Following Certain Orthopedic Procedures
- Surgical Site Infection Following Bariatric Surgery for Obesity
- Certain glycemic control-related conditions
- Deep vein thrombosis or pulmonary embolism following total knee replacement and hip replacement procedures

Available Topic Expert(s): For information on the listed expert(s), click appropriate link.
Andrew Webber

CONTACT: Cary Conway, +1-972-731-9242, cary@conwaycommunication.com, for National Business Coalition on Health

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