CMS’ List of Inexcusable Hospital-Acquired Conditions Targeted for Non-Payment

The epidemic of hospital-acquired illnesses has been ongoing for quite some time.  In fact, it seems to grow worse with each passing year.

Medicare/Medicaid has targeted certain hospital acquired conditions as unacceptable and subject to non-payment.  When one of these occurs, there is a good possibility that medical negligence was the cause.
Medicare/Medicaid has targeted certain hospital acquired conditions as unacceptable and subject to non-payment. When one of these occurs, there is a good possibility that medical negligence was the cause.

In the landmark 1999 study from the Institute of Medicine, it was estimated that as many as 98,000 Americans died each year as a result of preventable medical error.  Those estimates have gone up tremendously with some estimates, such as the Journal of Patient Safety, suggesting over 400,000 deaths each year from preventable medical error.

The key word here is “preventable.”  If it is preventable, then it is avoidable and it should not happen.  If it happens, taxpayers should not have to pay for it and that is just what the Centers for Medicare & Medicaid has determined.

Medical Negligence Crisis is Not What Most Have Come to Believe

When you hear of medical negligence crisis, most first think of greedy trial lawyers and opportunistic patients preying on the poor doctor who is just doing his best.  This is the result of a massive misinformation campaign begun and perpetuated by the medical malpractice insurance industry.

In fact, the crisis is the exact opposite of what most have come to believe. The reality is that medical negligence and the harm to patients and families has grown exponentially since the inception of the campaign to limit medical malpractice lawsuits.  At the same time, the number of suits has gone down tremendously and you guessed it, the profits of insurance providers on the backs of those same poor doctors have exploded.

Centers for Medicare & Medicaid Responds to the Real Medical Negligence Crisis

The Centers for Medicare & Medicaid Services (CMS) have not been fooled by the propaganda of the insurance and hospital industries.  To the contrary, there has been a fairly aggressive response.  That response has been to deny payment for hospital-acquired conditions that somewhat correspond to the National Quality Forum’s list of “never events.”

In a 2008 letter to state Medicaid Directors, CMS placed the states on notice of numerous hospital acquired-conditions that would not be covered by Medicare or Medicaid.  In other words, the hospitals were no longer getting paid for these avoidable and inexcusable complications, many of which lead to the wrongful death of the innocent patient and vastly higher numbers lead to serious and/or permanent harm to the patient.

CMS’ Targets Certain Hospital-Acquired Conditions under the Deficit Reduction Act

The CMS actually does not use the term “never events” but the essence is much the same in the hospital-acquired conditions that are targeted for non-payment under the Deficit Reduction Act of 2005.

CMS' target list for unacceptable medical error is somewhat less expansive than the National Quality Forum's list of "Never Events" making this list the honor roll of never events.
CMS’ target list for unacceptable medical error is somewhat less expansive than the National Quality Forum’s list of “Never Events” making this list the honor roll of never events.

The list does not exactly correspond with the National Quality Forums list.  In fact, the CMS list is less extensive.  As such, the CMS list might be considered the honor roll of “never events.”  These hospital-acquired conditions are inexcusable under CMS guidelines, subject to non-payment and for our purposes here suggestive of medical negligence.

List of “Never Events” on CMS’ Lists of Hospital-Acquired Conditions

Without further ado, here is the list of the CMS targeted medical errors.

The list below closely corresponds with the original 2008 list in the CMS letter.  However, it is somewhat more expansive and definitely more detailed than the original letter.

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  • Foreign Object Retained After Surgery
  • Air Embolism
  • Blood Incompatibility
  • Stage III and IV Pressure Ulcers
  • Falls and Trauma
    • Fractures
    • Dislocations
    • Intracranial Injuries
    • Crushing Injuries
    • Burn
    • Other Injuries
  • Manifestations of Poor Glycemic Control
    • Diabetic Ketoacidosis
    • Nonketotic Hyperosmolar Coma
    • Hypoglycemic Coma
    • Secondary Diabetes with Ketoacidosis
    • Secondary Diabetes with Hyperosmolarity
  • Catheter-Associated Urinary Tract Infection (UTI)
  • Vascular Catheter-Associated Infection
  • Surgical Site Infection, Mediastinitis, Following Coronary Artery Bypass Graft (CABG):
  • Surgical Site Infection Following Bariatric Surgery for Obesity
    • Laparoscopic Gastric Bypass
    • Gastroenterostomy
    • Laparoscopic Gastric Restrictive Surgery
  • Surgical Site Infection Following Certain Orthopedic Procedures
    • Spine
    • Neck
    • Shoulder
    • Elbow
  • Surgical Site Infection Following Cardiac Implantable Electronic Device (CIED)
  • Deep Vein Thrombosis (DVT)/Pulmonary Embolism (PE) Following Certain Orthopedic Procedures:
    • Total Knee Replacement
    • Hip Replacement
  • Iatrogenic Pneumothorax with Venous Catheterization

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Seek Legal Guidance – The Clock is Ticking

If you or a loved one has suffered serious personal injury or wrongful death as a result of one of the medical errors on this list, you may very well have a medical malpractice claim.

 

There are unique rules and deadlines on New Mexico medical malpractice claims.  Failure to abide by them can seriously jeopardize or even bar your claims.
There are unique rules and deadlines on New Mexico medical malpractice claims. Failure to abide by them can seriously jeopardize or even bar your claims.

There are a few things to note here:

1)  there are many unique deadlines and requirements for medical malpractice claims in New Mexico (several attributable to the afore-mentioned propaganda regarding the medical malpractice lawsuit crisis),

2)  in order to move forward with a lawsuit, there must be an expert review of the medical file with findings of medical negligence,

3)  collection and review of the medical records takes time and the clock is ticking.

Do not delay.  Missing a deadline or other requirement will bar your claims completely!

(505) 242-5958