Medicare's new regulations for deep vein thrombosis as a 'never event': wise or worrisome?

摘要

Patient safety has taken center stage in the discussion of our nation's health care system. Medicare's most recent strategy to reduce medical errors is to withhold payment to hospitals for treatment of serious preventable illnesses or complications termed "never events." The President's Fiscal Year 2009 Budget outlined this approach.6 This legislation prohibits hospitals from billing for these events. The legislation also requires that hospitals report occurrence of these "never events."6 The initial 3 in-hospital "never events" were: foreign object retained after surgery, air embolism, and blood transfusion incompatibility. The subsequent 5 "never events" were: severe pressure ulcers, falls and trauma, catheter-associated urinary tract infections, vascular catheter-associated infections, and mediastmitis after coronary artery bypass grafting. As of October 1, 2008, 3 additional "never events" were specified: surgical site infections following certain elective procedures, certain manifestations of poor blood sugar control, and deep vein thrombosis and pulmonary embolism occurring after total knee or hip replacement. This commentary will explore the merits and implications of classifying venous thromboembolism after total knee or hip replacement as a "never event."