The Beginning of the End is Upon Us
Posted by WhiteCoat on October 1, 2008
Today’s the day that CMS officially begins saving money by refusing to pay for those medical conditions that it believes should “never” happen.
The age of the “never event” is here.
Medicare won’t pay to prevent these never events. Medicare also won’t pay for proper care and staffing in the hospitals. Medicare just doesn’t want to pay period. As I mentioned in a previous post, the whole “never event” idea was part of the Deficit Reduction Act.
So how will hospitals respond to the challenge?
Here are my predictions:
1. You’ll get diagnosed with a lot more illnesses so that it is very difficult to determine what care is for a “never event” and what care is for the “never event.” Then when you have to stay in a hospital longer because of a “never event,” the hospital can allege that the extended stay was really due to a problem that was not a never event. That will mean more testing, more procedures, and higher costs.
2. If you develop a “never event,” you’ll be more likely to get transferred to another hospital. CMS won’t pay for never events if they develop in a hospital, but they will pay for treatment if you present with a pre-existing never event. Hospitals will develop unwritten agreements that certain specialists at each other’s facilities are better suited to treat a certain patient’s “never event.” More transfers mean more redundant testing, higher costs, and more complications from the testing.
3. Testing and diagnosis of never-event conditions will diminish where feasible. That bedsore isn’t a Grade 3 – it’s only Grade 2. CMS will pay for those.
4. Say hello to the Advance Beneficiary Notices. Medicare won’t cover preventative care, so you are going to have to pay for it out of your pocket. If you’re prone to falls or bedsores, you’ll have to pay for a personal nurse to wait on you hand and foot so you don’t develop these never events. If you don’t pay for a personal nurse 24 hours around the clock to keep a never event from happening, you’re personally responsible for paying the costs of treatment if the “never events” occur. You had the opportunity to prevent the events but you were just too cheap to pay for it. I think that ABNs are less likely to catch on, but eventually I think they will become commonplace.
The name of the game is cost-shifting, folks. Medicare forces you to pay into the system through payroll deductions. The government has vastly underestimated the costs of this entitlement. Now as we enter the Baby Boomer retirement era, just like an insurance company, the Feds have to prevent everyone from taking as much out of the system to try to keep the system viable. Therefore, they cut back on providing care and cut back on payments to hospitals. But the hospitals need to get money from somewhere to keep the doors open and the lights on. The only other variable in this equation is the consumer. Yep, you and I are left holding the bag.
We’ll be responsible for paying thousands and thousands of dollars more for our care until the costs engulf us all (if they haven’t already).
Once the duck juice has been squeezed out of us, everyone will beg for some way out of it.
Enter the knight in the shining armor – the same government that put us into this mess. “Let’s try universal healthcare/single payor,” the knight says from atop his noble steed.
Then the Golden Rule will apply: He who has the gold makes the rules.
Whichever way you look at it, healthcare as we know it is about to change for the worse.
We’re screwed.
rlbates said
“If you develop a “never event,” you’ll be more likely to get transferred to another hospital.” — Is this a loop hole? I thought that the fact that it developed in “A” hospital made it a “never event”. You may be right on all your predicitions. Sad.
HyperAl said
A dirty, rusty screw would have been more appropriate for your picture so we can all get “Lock Jaw” and die..wait is that considered a “Never Event”….darn.
mhf said
We’re definitely screwed. Medicare will look at the lower incidence of “never events” (due to clever manipulation by the health care industry) and conclude that its policy worked. This will lead CMS to create even more painful “money-saving” policies.
Years from now, epidemiologists will look back on the stats for this period of time and draw some interesting conclusions about medicine at the turn of the 21st century.
Anti-vaxers will interpret the information to mean it’s more dangerous than ever to vaccinate their kids. We’ll witness the return of all hitherto virtually eradicated diseases, and the U.S. death toll will climb.
The WHO will issue travelers’ advisories to foreign nations to protect them from us, and wealthy tourists will spend the summer in Singapore instead of Palm Beach.
Resort areas will go out of business; the leisure industry will tank; and the U.S. will plunge into yet another recession.
Wall Street will panic; the Dow will plunge; and Congress will be thrown into turmoil. We’ll have yet another bail-out to fund out of taxpayers’ pockets.
The new “never event” policy will actually end up costing the United States several trillion dollars, but CMS will come out smelling like a rose for their brilliant cost-containment strategies.
keepbreathing said
Where I’m from we used to refer to this as a reverse pineapple, as in “they’ve got you over a barrel and the reverse pineapple is coming…”
Yeah, we’re screwed. Possibly even pineappled.
Uh-Oh. « Respiratory Therapy 101: Just Keep Breathing said
[...] Uh-Oh. October 1, 2008 Posted by keepbreathing in Uncategorized. trackback The age of the Never Event has arrived. Be afraid. [...]
crankylitprof said
Quaaaaaack.
CMS is just rodgering the duck before inserting it in to the press. The resultant squeezin’s will be a bitter draught to swallow for the patients/public.
Susan M said
I sent an email to my uncle (a physician) this morning with a link to your site offering my sympathy. He sent a reply back worried never events could increase law suits against doctors and hospitals.
I guess if it’s “never” supposed to happen, then the hospital or doctor must be negligent in their care or practice if it does happen = law suit. Scary thought. What do you think Dr. WhiteCoat?
Jeremiah said
Well we had an equivelent of a financial 9/11 just recently…so it wouldn’t be right to leave the health care system out of the fun. So can we say that this maybe a healthcare 9/11! Should be interesting. Thanks for keeping us informed!
Don Salva said
Wooah, I’m so glad I live in Germany…
Seriously….”never event”…, pardon my french in advance, what the fuck?
No preventative care? Holy shit…
A lá “Well, I kinda figured why the hell should we pay for preventative care if we can scratch it altogether. I figured the death toll will be about the same as if we would continue paying preventative care. Here look at that, those statistics support my claim!”
What kind of retards are sitting in America making up the numbers for politicians to pass such retarded laws?
Don’t take me wrong, I believe in the “Land of Dreams”, I believe in (not too) liberal economy, but somewhere along the line it need to be regulated and socialized. It’s time for a mentality change in America!
ERP said
We have been getting a raft of shit for putting in foleys to demented old people with fevers for fear they will develop a catheter induced UTI. I think you are right – in many cases, doctors and RN’s will be encouraged to document creatively so that never events never appear to occur.
CountyRat said
rlbates asked: “`If you develop a “never event,” you’ll be more likely to get transferred to another hospital.’ — Is this a loop hole? I thought that the fact that it developed in “A” hospital made it a “never event”.”
No, rlbates, that is not how it works. If the patient develops the never event condition while in hospital A, hospital A cannot be reimbursed for treating the never event. However, if the patient is transferred from hospital A to hospital B, the condition existed at the time hospital B received the transferred patient, so hospital B can be reimbursed.
What CMS is doing is applying punitive, legalistic approaches to biological events. Complications happen because the patient is sick, and so, more vulnerable to new health problems. The sicker the patient is, the more complications he or she is vulnerable as they recover. We do what we can to prevent complications, but debilitated patients are very fragile and we cannot prevent every bad result. Supporters of never events actually believe that the way to alter the outcomes of biological phenomena is to make a rule prohibiting that phenomena, and punishing someone when it occurs.
Do not try to understand this rationally; rational analysis does not apply in government dictated healthcare. You can only understand it in terms of politics and bureaucratic incompetence. No other categories work here.
arfin said
The new rules about “never events” have some interesting incentives. The hospital and the physician is punished financially for keeping the sick patient with one of these problems they say should never happen. Some of these problems are to be expected in certain critically ill patients( think sternotomy infections in the obese , ill diabetic). Now there are interesting new incentives: deny service or get rid of the patient if they develop on of these conditions. SO, preventing this costly problem can be accomplished by: well planned denial of service, transfer or extermination. Deny service without explicitly doing so by delaying until payable problems develop. Transfer can be managed by inter- hospital collusion. But now and again we will have to recognize the incentive to kill the patient.
mottsapplesauce said
This all gives new meaning the the phrase ’slippery slope’….
mottsapplesauce said
P.S., this post sheds a different light on the ABN. There are all kinds of pros & cons that go along with that little form. I’ll elaborate on that later….
gmlevinmd123 said
The real never event is, “never get paid”.. CMS in it’s latest well thought out blunder was contracting with a new fiscal intermediary in an attempt to become ‘more efficient’. They reduced the number of intermediaries from 45 or so to 15….in California this new entity is
Palmetto, LLC. Many providers are complaining they are not receiving payments, and unable to reach customer service reps….
Medicare adopts “never event” policy said
[...] White Coat Rants, who has blogged extensively on the issue in past months, has some predictions (Oct. 1) of things we can now expect to see more of: more patient transfers between hospitals (since [...]
rxc said
This is the medical equivalent of the “mark to market” rule that is causing the current financial meltdown – a rule passed by a Congress that is determined to ensure that something “will NEVER happen again”, because something that is CERTAIN to happen again in the future, got blown all out-of-proportion by the chattering classes. For an engineer, it is a classic example of setting up a system in such a way that is is sure to fail in the future, catastophically(sp?), as soon as the appropriate trigger is indentified and set in motion.
Let’s all give a cheer to our politicians, and the people who swarm around them, and live off of them….
mottsapplesauce said
Back to the ABN, our company only uses it to protect the company. Our goal is to not stiff the patient. We’ve just been burned so many times by our clients so we just want to be careful. I can’t speak for the other providers, but we still fight to get those claims paid, whether or not an ABN is on file. Besides, an ABN doesn’t guarantee that you can bill the patient. It has to be filled out properly, & there has to be a
‘valid’ reason that you suspect the claim will be denied. The ‘validity’ of the signed ABN is not determined by the provider. For example, if you appeal a claim that was denied by Medicare as a contractual obligation, & send in a copy of your ABN, if Medicare feels you didn’t state your reasons clearly or specifically enough, you may still have to eat that claim.
bayofammoudi said
A never event. I had to help save a woman tonight who had septic shock because she couldn’t afford the $800 antibiotics that her insurance refused to cover.
Where is my very very large soapbox when I need it most?
Charles Pergiel said
Just what are “we” trying to do? Provide adequate medical care for everyone? Can we, the nation, afford it? Could we afford it if we quit spending so much on defense? Or oil? Or maybe if we just got rid of all the insurance companies and the government bureaucracies, it would cut costs so much that everyone could afford it.
$800 for antibiotics?!?! Is that part of the problem, or part of the solution?
Just what are “we” trying to do?
Grandly Rounding, MDOD Style… said
[...] White Coat Rants makes a tear well in our eye with his post detailing the idiocy produced when committees morph into bureaucracies and then into government oversight entities. And this all for the sake of money shuffling and vote buying. Outside of the academy, Medicine is dying, patients are dying, and doctors are the whipping boys of the moment. Check this one out too. [...]
Ariel said
Another reason to NEVER accept medicare. I am fresh out of residency and am already considering returning to my old job as perosnal trainer. With my master in exercise physiology and MD plus three years of residency, I might make 80K at the gym. Still preferable to call, lawyers, medicare waiting to jail me for “fraud” and “NEVER” events.
What about NEVER medicare!!?!?
ncs757 said
Wow ariel, where can I sign up? I also have a masters in exercise physiology, three years of residency, board certification with two recerts and twenty years practice experience. I’ll net $150,000 this year as a solo FP. 80K as a personal trainer sounds pretty sweet!
John said
It’s really amazing when you look at the requirements that CMS puts on all sorts of providers. The pharmacy field has it pretty bad too; look at Colorado, where the government “graciously” gives reimburses a pharmacy “AWP – 15%”, which translates to “Well, whatever the average wholesaler charges for the drug, we’ll give you 15% less than that.” No, not 15% less than your own acquisition cost, but 15% less than an average wholesaler price. On top of that, you get a $4 dispensing fee to pay for the pharmacist’s time/knowledge/etc., no matter how much work went into filling a prescription. [Haha yes, I know, go ahead and make jokes about how much knowledge is required to fill a prescription!]
This is why government “health coverage” is so dangerous – it doesn’t behave like any other free market force does. If you don’t recoup your costs based on their payment, tough luck, says CMS; when you agree to be reimbursed, you also agree that you cannot charge the patient for anything beyond what they may authorize as the copay. No recourse, no solution.
This creates a horrible cycle in the end; doctors, pharmacists and other health care providers stop accepting Medicare/Medicaid due to the crappy treatment. This leads to an increase in visits to more expensive tiers of care (ER visits for all!), driving up expenses for the government program, which in turn creates painful regulations like this, trying to “fix” the problem.
Anyway, it’s a horribly dumb idea on their part to have these “Never” events and just another example of how government can get it wrong, making things worse for their patients in the end.
Excellent blog!
Cannon’s comments draw fire « Dr. Bobbs said
[...] And, of course, the incentives created by this initiative will themselves include costs and complications. I suspect a good many bloggers are drafting their “I Told You So!” posts [...]