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CMS “Never Events” Incentivize Physicians To Avoid Caring For High Risk Patients

In 2008, the Centers for Medicare and Medicaid Services (CMS) announced it would no longer pay for the treatment of “never events,” i.e., certain medical conditions in hospitalized patients which the Feds deem to be universally avoidable under all circumstances. These conditions included:

* Decubitus ulcers
* Two kinds of catheter-associated infections
* Air embolism
* Mediastinitis after coronary bypass surgery
* Transfusing patients with the wrong blood type
* Leaving objects inside surgery patients
* In-hospital falls

Then, having been delighted with the results of its original list (or dismayed that healthcare costs continued to skyrocket despite its original list) CMS subsequently proposed declaring several new conditions as “never events,” including: Read more »

*This blog post was originally published at The Covert Rationing Blog*

Book Review – Over the Edge: Death in Grand Canyon

Michael Gighlieri and Thomas Myers are coauthors of Over the Edge: Death In Grand Canyon, which is one heck of an interesting read. It is an encyclopedic rendition of all of the fatal accidents known (at the time of the writing) to have occurred in the Grand Canyon. The over-arching observation, made by the authors and almost certainly by the readers, is that the vast majority of these deaths were avoidable. Failure to recognize risk, or frank disregard for hazards, led to tragic loss of human lives. For every person who died, countless more suffered.

Early in the book and at intervals thereafter, the authors apologize for the graphic descriptions and for articulating the opinion that the fatalities were avoidable. They are apologizing for accurately observing that people can be uninformed, or informed and foolish. There is, of course, an element of risk inherent in many outdoor recreational activities, but the authors present an entirely different spin on risk – namely, unambiguously unnecessary risk. They are correct – too many people have paid the price, in the theme of this book, with loss of life and great emotional suffering (presumably) to family and friends.

There is a bit of adventure in the telling of tales, but this is not an adventure book. It is, rather, a series of accountings, some written in great detail and some more superficially. There is nothing boring about this book, but it is easily put down after a section is completed.

From the back cover: “Two veterans of decades of adventuring in Grand Canyon chronicle the first complete and comprehensive history of Grand Canyon misadventures. These episodes span the entire era of visitation from the time of the first river exploration by John Wesley Powell and his crew of 1869 to that of tourists falling off its rims today. These accounts of the nearly 600 people who have met untimely deaths in the Canyon set a new high water mark for offering the most astounding array of adventures, misadventures, and lifesaving lessons published between two covers. Over the Edge promises to be the most intense yet informative book on Grand Canyon ever written.”

The major and minor sections represent the categories of accidents: falls from the rims, falls within the canyon, heat illness (and dehydration), flash floods, river accidents (including crossings and drownings), air accidents, rockfall, envenomations, freak accidents, suicide, and murders.

The book is replete with lessons learned and safety advice – all of it useful for educators, adventurers, explorers, search and rescue personnel, and casual visitors. The book truly serves a purpose, which is to articulate history in such a way that the reader can learn from it, and hopefully, avoid the catastrophes that befell the unfortunate victims portrayed in these tales. Other interesting books co-authored by Dr. Myers are Fateful Journey – Injury and Death on Colorado River Trips in Grand Canyon and Grand Obsession – Harvey Butchart and the Exploration of Grand Canyon.

This post, Book Review – Over the Edge: Death in Grand Canyon, was originally published on by Paul Auerbach, M.D..

The Ultimate Criterion For A Hospital “Never Event”

As many of you know, I’ve been pretty upset about the “never events” policy put forward by CMS. That’s because they took a theoretically reasonable punitive rule (Medicare will not pay hospitals for patient care related to gross medical errors, aka “never events,” like wrong-side surgery) and made it far too general (never events include delirium, falls, and any infection – even a cold). It is absolutely impossible to prevent these sorts of things 100% of the time. So how should “never events” be defined?

The Happy Hospitalist nails it:

Can the never event happen at home? If the answer is yes, it cannot be a never event. It is a natural event. Even the criminal events that nobody can foresee are considered never events. Tell me how a hospital can prevent a random crazy family member or hospital guest from going berserk and assaulting an employee or patient. It’s impossible to predict or prevent.

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