Occurrence of some so-called "never events" in hospitals may depend partly on unmodifiable risk factors such as patient characteristics, undermining the rationale for denying Medicare payment for their treatment, researchers said.

Below you can find the highlights of the article by John Gever as on medpagetoday.com, based on the study “Patient Characteristics and the Occurrence of Never Events” by D. Fry in Archives of Surgery.

Never events are serious, largely preventable patient safety incidents that should not occur if the available preventative measures have been implemented.

Analysis of some 890,000 surgeries performed in 1,368 hospitals showed that patient age and pre-existing conditions such as weight loss and chronic renal failure greatly increased the risk of "never event" complications including surgical site infections and decubitus ulcers, reported Donald E. Fry, MD, of the consulting firm Michael Pine and Associates in Chicago, U.S.A., and colleagues.

"Calling these complications never events and refusing to pay for their treatment may advantage high-quality caregivers, but it also will penalize providers that care for the most vulnerable patients or that perform procedures with higher-than-average risk," the researchers wrote.

The list of Medicare's "never events," first implemented in 2008, includes overt mistakes such as wrong-site surgeries, objects left in the patient after surgery, and transfusing the wrong blood type. But it also includes a variety of other complications -eight of them where studied- that may not be entirely preventable like falls in the hospital, catheter-associated vascular infections and post-operative pneumonia.

For each of the eight complications, certain patient factors were associated with substantially increased risks. Older age was particularly common in this regard, as were malnutrition and weight loss and chronic kidney failure.

“Payment to cover the cost of caring for potentially avoidable complications should be based on empirically derived rates and costs of complications for providers who deliver documented high-quality care, “ Fry states.

In particular, Fry and colleagues advocated what they called "risk-adjusted warranties" that take account of providers' degree of control over complications in determining financial rewards and penalties.

Under this system, providers would receive a warranty payment to cover costs of treating theoretically preventable complications that, statistically, are bound to occur even with the best-quality care. The amount would be calculated by multiplying the probability that a complication will occur with high-quality care by the predicted average cost of treating it.

Providers would then be responsible for the costs associated with all such complications that occur, Fry and colleagues explained.

Jana B.A. MacLeod, MD, of Emory University in Atlanta, U.S.A., agreed that risk adjustment is a better approach than the one taken by the Medicare system."This study provides an evidence base to discuss whether unconditional preventability of complications, even in the environment of evidence-based treatment guidelines, actually exists," MacLeod wrote.

"In our attempt to eliminate the avoidable, we cannot allow the public and private health care funding groups to punish us for the inescapable."

Source: medpagetoday.com