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Speaker addresses labeling problems for orthopedic ‘never events’
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Orthopedic surgeons can manage “never events” in their practice like deep vein thrombosis or pulmonary embolism through careful preventative treatment and awareness of at-risk patients; however, some conditions are not preventable despite labeling by federal agencies.
“I think this discussion of ‘never events’ that has been brought upon us by outside groups has raised our awareness and our efforts to minimize harm or complications to our patients,” Daniel J. Berry, MD, said in his presentation at the Current Concepts in Joint Replacement Spring Meeting. “At the same time, we need to mitigate the unintended negative consequences of labeling problems that are not completely preventable as ‘never events.’”
Daniel J. Berry
Berry said the National Quality Forum (NQF) has a list of serious reportable events, while CMS has a different list of non-reimbursable hospital-acquired conditions. The CMS list overlaps with the NQF list in some areas, but also contains broader events that are considered reasonably preventable hospital-acquired conditions. Conditions on the CMS list include surgical site infection of the spine, shoulder and elbow, deep vein thrombosis (DVT) and pulmonary embolism (PE) after total hip or total knee arthroplasty.
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“Part of the problem is the conflation of the NQF Serious Reportable Events list and the CMS non-payment list all under the term ‘never events,’” he said. “We need to keep those lists separate because they are fundamentally different, or at least many of the things on the list are different.”
Another issue lies in how CMS classifies some hospital-acquired conditions. The conditions are not called “never events,” but CMS will not reimburse an institution when they occur.
“There is a gap between the admirable aspirations of trying to prevent a problem, and the realities of surgical practice where some problems occur despite our best efforts to prevent them,” Berry said.
The system of classifying conditions like DVT and PE as preventable does not incentivize surgeons to take into account the most at-risk patients, which could create a potential access-to-care problem, he said.
“We as surgeons can complain about the idea that nothing should be called ‘never.’ No doubt many infections, DVTs and PEs are not actually reasonably preventable,” Berry said. “But, we would also admit that we want improved quality of care for our patients and believe there can be room for improvement in all our practices.”
Reference:
Berry DJ. Paper #24. Presented at: Current Concepts in Joint Replacement Spring Meeting. May 19-22, 2013; Las Vegas.
Disclosure: Berry receives royalties from DePuy.