Nursing Research Paper on Implications of CMS Reimbursement Rules

Implications of CMS Reimbursement Rules

In 1999, IOM committee, in its report known as To Err is Human: Building a Safer Health System, said that medical errors caused deaths of between 44,000 to 98,000 people in hospitals annually in United States only. The committee concluded that the deaths were, as a result, of a flawed healthcare system and that the errors were preventable (Kohn et al., 2000).  As part of reforming the quality of healthcare, two organizations; National Quality Forum and Leapfrog Group came up with a list of twenty-eight serious reportable events. It is a list that contains unacceptable errors, deemed as preventable by healthcare providers (Blankenship, 2008). From the NQF list, the Centers for Medicare and Medicaid Services (CMS) extracted its currently seventeen non-reimbursable hospital-acquired conditions (HACs) referred to as never events. According to Lembitz & Clarke, 2009, CMS asserts that the HACs conditions are “reasonably preventable through the use of evidence-based guidelines.”

In 2007, the cost of the seventeen HACs was approximated to be $43 billion and, therefore, by implementing the CMS non-reimbursement policy it significantly reduces the federal healthcare budget (Blankenship, 2008). Consequently, hospitals would be forced to hasten the implementation of quality improvement standards that would mitigate risks of never events. The IOM report blamed the state of affairs and processes in hospitals, in that they did not enhance patient safety and reduce errors by healthcare professionals. In addition, lack of a coordinated system led to the loss of critical information when patients were attended by various healthcare providers (Kohn et al., 2000).The never events call for coordination of healthcare between hospitals and physicians. It necessitates for a thorough diagnosis of preexisting conditions before admission, and documentation that would facilitate hospitals in asking for reimbursements. Thus, patients will be thoroughly examined for all overall health conditions. In addition, physicians will be more careful exercise extra caution to avoid blames of negligence in medical liability litigation (O’Rourke & Hershey, 2009). As a result, hospitals develop standards preventing never events, and physicians will be able to defend themselves in negligence cases, leading to the provision of utmost healthcare.


Kohn, L. T., Corrigan, J., & Donaldson, M. S. (2000). To err is human: Building a safer health system. Committee on Quality of Health Care in America, Institute of Medicine, National Academy Press, Washington, D.C. Retrieved on 15 July, 2014 from

Lembitz, A., & Clarke, T. J. (2009). Clarifying “never events” and introducing “always events”. Patient safety in surgery3(1), 26. Retrieved on 15 July, 2014 from

O’Rourke, P. T., & Hershey, K. M. (2009). Never-Event Implications: What to do—legally—when a patient questions the care you provided. The Hospitalist, February 2009. Retrieved on 15 July, 2014 from

Blankenship, C. (2008). Non-Payment of Never Events: Implications for Practice. American Health Lawyers Association Physician Organizations Practice Group, 11(2), N.p. Retrieved on 15 July, 2014 from