Healthcare facilities are very active institutions. Each part must be functioning correctly, from delivery systems and issues of Managed Care and Centers for Medicare and Medicaid Services (CMS), to the National Quality Forum (NQF). These different parts of healthcare facilities are constantly dealing with many different situations that arise. Sometimes circumstances that should not take place occur. These types of circumstances are known as Never Events.
As these events rise in number, the safety of patients is decreased; this forces the healthcare facility to find new and improved ways to ensure the safety of patients and reduce medical errors. Never events are dangerous and should never be allowed to occur. The issue of never events has become such a huge event that starting October 1, 2008 Medicare refuses to reimburse hospitals in the case of patients that have suffered these events. Patients are also not allowed to be billed for these incidents; it is the responsibility of the hospitals to pay for harm and damages.
By doing this Medicare has made sure to improve the safety and value of patients’ lives (Lippmann, 2008). An example of a never event is the following: someone suffering from a spinal injury in an ambulance is being rushed to the emergency room. When the patient reaches the hospital, they are placed on a gurney. Suddenly, the gurney is spotted rolling down the hallway of the hospital by itself without anyone to direct it to where it needs to go. The unfortunate patient crashes into a wall and is permanently paralyzed. This type of situation could and should have been avoided.
While the Center for Medicaid and Medicare Services states that it would never pay for the charges of never events that occur in a healthcare facility, it will pay for the treatment of a patient who is suffering from the consequences of a never event. In 2008, the Center for Medicaid and Medicare Services stated that it would stop paying for the damages of Never Events because approximately twenty states have either started removing or are removing the cost of payment for never events from their healthcare facilities.
Some insurance companies, like WellPoint, have also started taking action in eliminating payments in the case of never events. Removing the payment of these events in every state has proven difficult because each state has its own laws regarding never events. Regardless of the state’s laws, Medicare will not pay for any charges that the hospital has billed a patient from never events if it came from that hospital (Lippmann, 2008). The National Quality Forum is a voluntary consensus standard setting organization first was established in 1999.
Its mission is “to improve the quality of American health care by setting national priorities and goals for performance improvement, endorsing national consensus standards for measuring and publicly reporting on performance and promoting the attainment of national goals through education and outreach programs” (Fuhrmans, 2008). This consensus made steps toward making an improvement regarding patients’ safety due to medical errors. The NQF views safety as a fundamental characteristic as well as the importance of quality healthcare.
All this is to identify and authorize never events (Fuhrmans, 2008). These preventable medical errors often lead to serious medical issues and in some cases death and result in more than 4. 5 billion dollars in additional health spending every year (Fuhrmans, 2008). These alarming results need to be decreased. They can only be stopped by the total awareness and motivation of hospitals and engaging staff. Most patients who have suffered from medical malpractice are unaware they are suffering from an occurrence that never should have happened in the first place.
Patients who are being tormented because of medical errors have actions that they can take to be compensated for these occurrences, but they can only know this if they are fully aware of the problem. Patients can now access information about different types of never events from the Internet. It is important that their knowledge of these events is raised so that in the unfortunate event of their falling victim to such an occurrence, they know exactly what type of action to take. The increased awareness of patients leads to two problems that healthcare organizations must face.
The first problem: the patients’ trust and engagement of these never events would never have came about if it were not for the negative publicity that comes from such an event happening. If a never event either happens to a patient or in a hospital that the patient goes to, then that patient would have less trust towards the healthcare facility overall. The one thing that healthcare organizations need is their patients’ trust. The second problem: insurers are beginning to hold healthcare facilities financially responsible for never events (Ozan-Rafferty).
As a result, physicians and hospitals have to pay for the care they provided, in addition to the errors that they encountered. If the insurers do this, it would bring the downfall of the entire hospital because there would be so much expenses that the healthcare facilities have to pay that it may not be able to pay for most of the debts that they have in the facilities. Motivating hospitals to ensure proper policy is followed can lead to a reduction on spending every year due to medical errors.
Holding healthcare facilities responsible for these medical errors is the key to motivating them to do more and to better to prevent these errors from even existing. The new rules that the CMS has put into action threaten to increase the practice of defensive medicine and will eventually expose physicians to extra lawsuits. Also, patients who are experiencing or have experienced preventable errors can create a high distrustful healthcare climate. Every patient expects excellent treatment but “when something goes wrong patients lose confidence in their own provider and that is when malpractice lawyer’s phone can start ringing” (Ozan-Rafferty).
In order for things to go on the right path and to prevent negative things from occurring by the employees or doctors in healthcare facilities, the hospital needs to have engaging staff. Having the staff being engaged in what they are supposed to do as employee’s leads to an active commitment. Employees will be more mentally attached to their work place, making sure nothing dreadful will happen under their care that can damage the healthcare facilities as a whole. This would decline the possibilities of hospital errors.
They need to have some potential of employee engagement. “Although personality and job type do affect engagement, in hospitals, it’s equally possible to engage a neurosurgeon as it is to engage a housekeeper” (Ozan-Rafferty). Even though there may be things that can affect a person’s engagement towards their work field, they need to be shown by the organization that they are cared for and needed and that they have all the materials or equipments that they will need to manage their job properly.
Staff engagement can also lead to better healthcare outcomes, such as minimizing never events. A study shows that hospitals with higher nurse engagement levels have statistically lower mortality and complication indices. This would be great to encounter in any type of healthcare facility because they are most likely paying for or dealing with the mistakes they have caused and with these type of engagement going on in the work place it can be seen as a money back guarantee. This means that if there is an engaged staff, the revenue would be declining instead of increasing.
The cause some events are unknown and as a result it can lead to tragic deaths and other health costs: “The Agency for Healthcare Research and Quality reports that medical errors are responsible for injury in 1 out of every 25 hospital patients, and it estimates that 48,000 to 98,000 patients die from medical errors each year”. (Ozan-Rafferty) This is one of the main reasons why patient’s safety should be the main priority under the hospital’s care. If their safeties are at risk and if they are suffering from pain, then the hospital would suffer too, therefore reducing hospital cost.
Less tragic Never events can lead to hospital readmission. This is something that can be fixed by the hospitals case and disease managements. Case management is a method of managing the provision of health care to members with high cost medical conditions. The goal is to coordinate the care so as to improve both the quality and continuity of care and lower costs (Konfstvedt, 211). Disease management is the process of intensively managing a particular disease. It encompasses all settings of care and places a heavy emphasis on prevention and maintenance (Konfstvedt, 218).
Healthcare facilities’ managements need to have requirements that they follow in order to reduce readmissions. The case manager will develop an ongoing plan of care and will work with both the patients and their families to assist them in regaining their health or resolving whatever situations they may be facing. The case manager’s goals can be to review a patient’s health benefits and to implement an effective strategy, prevent progression and manage complications reduce mortality, etc. The disease management will need to have a program that can provide education to members and/or their caregivers to empower self management.
These members will receive educational mail, newsletters, and emails that will have the latest information on treatment. Also there would be a twenty-four hour nurse line that would guide the patients with answers to their questions that they may worry about or in general; triggers to avoid and to ensure they are receiving the appropriate medications or treatments. By applying these programs, it will improve patient’s outcomes and reduce general healthcare cost. In conclusion, never events should ever occur in any healthcare facility.
There are always consequences to face by all the cost. These events can be prevented by hospitals taking steps toward eliminating them such as ensuring total awareness, motivating hospitals and engaging staff. Actions need to be taken under these circumstances. No one wants to pay for something that should have been prevented if the patient had had better care in the first place. Works Cited Page Fuhrmans, Vanessa. “Insurers Stop Paying for Care Linked to Errors Health Plans Say New Rules Improve Safety and Cut Costs; Hospitals Can’t Dun Patients.
” Online. wsj. com. N. P. , 15 Jan. 2008. Web. 3 Dec. 2012. Kongstvedt, Peter R. Managed Care: What It Is and How It Works. Sudbury, MA: Jones and Bartlett, 2009. Print. Lippmann, Q. K. , Seth D. Crockett, Evan S. Dellon, and Nicholas J. Shaheen. “Quality of Life in GERD and Barrett’s Esophagus Is Related to Gender and Manifestation of Disease. ” The American Journal of Gastroenterology (2009): n. pag. Print. Ozan-Rafferty, Maggie. “Hospitals: Never Have a Never Event. ” Http://businessjournal. gallup. com. N. P. , 7 May 2009. Web. 3 Dec. 2012.