How Far Will CMS Go?

Maureen Larkin, for HealthLeaders Media, April 17, 2008

As I was putting together this week’s edition of QualityLeaders, the Centers for Medicare & Medicaid released nine new proposed “never events” that hospitals won’t be reimbursed for if they are acquired while a patient is receiving care at the organization.

These conditions include:

  • Blood clots in the vascular system
  • Bloodstream infections
  • Ventilator-associated pneumonia
  • Legionnaire’s disease
  • Delirium
  • Collapsed lung as a result of medical treatment

The nine new conditions on the “won’t reimburse” list aren’t much of a surprise to anyone. Many of the quality leaders I’ve spoken with in recent weeks seemed to expect that the original eight on CMS’s list would soon have company. Some even went so far as to say that the first eight were the “low-hanging fruit” or the most obvious of the conditions that hospitals must take care of to provide quality and safe care to patients. But what do these new additions tell us about where CMS is headed? Are they reasonable?

James Kennedy, MD, CCS, of FTI Healthcare in Brentwood, TN, told my colleague Lisa Eramo that although the majority of the new conditions listed by CMS are reasonable, there are some that raise eyebrows. For example, patients can acquire Legionnaires’ disease both in and out of the hospital setting, particularly through air conditioning units that contain waterborne pathogens. Certainly, he says, patients have acquired the disease from hospital air conditioning units, but it isn’t clear how hospitals will determine if the condition was present on arrival.

The additions of clostridium difficile colitis and delirium have also been questioned, as these two conditions often occur as a side effect of medication or being in the hospital for expanded periods of time.

Fortunately, CMS gives us until June 13 to comment on these proposed additions before it releases the final rule on or before Aug. 1. Will you be sending your comments? If so, what will you tell them? Do you think your feedback will be addressed in the final rule?

A note to my faithful readers: In last week’s column, I promised to introduce you to more “zero heroes.” I haven’t forgotten about them. Stay tuned.

Maureen Larkin is quality editor with HealthLeaders magazine. She can be reached at

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