Defensive Medicine?

Foster says the CMS list offered last year met with the legislation's intent—never events that hospitals could prevent by using proper science. The new proposed list, however, includes items that hospitals have not learned to control, she says. For instance, there simply isn't the evidence-based knowledge to help hospitals prevent conditions like Legionnaire's disease, says Foster.

Wachter foresees a time when hospitals might perform extra tests for each admitted patient to make sure they don't lose out on reimbursement later. He says these situations could squander resources and cause harm to patients. "This really does change the pressure that comes down on frontline providers from on high to look good on these things," he says.

Quality focus
Not all providers share Wachter's concern about the impact of CMS' latest list of never events, however. Officials at the 159-staffed-bed Delnor Hospital in Geneva, IL, don't expect the changes will significantly affect the facility; the added emphasis on quality will merely sharpen the hospital's focus on documenting conditions and protecting patients, says Marie Lee, director of quality improvement.

John Hubbe, vice president of medical and legal affairs who oversees quality at the hospital, says one area in which Delnor will feel some effects is staffing. The hospital expects a larger workload to properly document present-on-admission conditions and has hired two people whose duties include helping with concurrent coding to handle the present-on-admission tracking. In addition, the hospital has also increased communication with physicians and the medical staff to make them aware of the CMS changes.