'Never events' increase Medicare costs, but reporting is not transparent

Studies have shown that “never events” add significantly to Medicare hospital payments, ranging from an average of an additional $700 per case to treat pressure ulcers to $9,000 per case to treat postoperative sepsis.

Yet we still don’t know how often never events occur because they’re not recorded very transparently, says Leah Binder, CEO of the Leapfrog Group. She said the jury is still out on how much 'never events' really cost health systems each year.

“I would like to think that the financial implications would be minimal -- because I’d like to think that they are extremely rare,” Binder said, noting that recently enacted federal rules no longer reimburse hospitals for charges associated with many such never events.

Leapfrog represents purchasers of healthcare, and there’s an outrage factor involved with never events, said Binder.

“It shouldn’t be tolerated that anyone could be charged for these events, it’s astounding that there isn’t automatically an apology and that they even happen,” she said.

Never events include preventable problems such as falls, foreign objects being left in a patient’s body after surgery, infants being discharged to the wrong person, or patient death or serious disability associated with a medication error.

While the exact number of never events is unknown, it’s estimated that these events result in many injuries and deaths every year, as well as millions of dollars in additional healthcare costs, said Heather Herdman, executive director of NANDA International, a professional nursing association that develops, refines and publishes terminology that accurately reflects nurses’ clinical judgments.

The National Center for Injury Prevention and Control, part of the Centers for Disease Control and Prevention (CDC) has estimated the total direct cost of all fall injuries for people aged 65 and older. From $19 billion in 2000, the cost is expected to more than double by 2020, to $54.9 billion.

“I don't think you will find anyone pointing fingers at healthcare professionals - be it nurses, physicians, other professionals," Herdman said. "It is usually a case of systems or processes breaking down, often coupled with inadequate staffing and high patient acuity."