This report should not surprise any practicing physician. Only those who study data and have left the bedside could imagine the concept of never events (other than a few obvious ones that the article acknowledges).
'Never Events' Not Always Preventable
Analysis of some 890,000 surgeries performed in 1,368 hospitals showed that patient age and pre-existing conditions such as weight loss and chronic renal failure greatly increased the risk of "never event" complications including surgical site infections and decubitus ulcers, reported Donald E. Fry, MD, of the consulting firm Michael Pine and Associates in Chicago, and colleagues.
Rates of such complications also varied dramatically by the type of procedure, the researchers indicated in their report, published in the February issue of Archives of Surgery.
Colon resection appeared particularly vulnerable to "preventable" complications. It was associated with C. difficile enterocolitis, methicillin-resistant Staphylococcus aureus infections, surgical site infections, and decubitus ulcers with odds ratios of 2.4 to 21.3 relative to the least risky procedures, the researchers found.
Other procedures were associated with relatively high rates of certain complications as well.
Fry and colleagues argued that the findings demonstrate the unfairness of Medicare's policy, increasingly followed by private insurers as well, to deny all reimbursement for costs associated with treating "never events."
"Calling these complications never events and refusing to pay for their treatment may advantage high-quality caregivers, but it also will penalize providers that care for the most vulnerable patients or that perform procedures with higher-than-average risk," the researchers wrote.
Those who wonder why practicing physicians so often feel outrage when Medicare and insurance companies make rules should read this piece. We understand that "The best laid schemes o' mice an' men Gang aft agley". We who care for patients must do everything to maximize safety and provide high quality care. But we do not operate on machines. Our patients have great complexity and that complexity can lead to complications. We should do our best to minimize complications, but only a bureaucrat could image a lack of complications. The editorial to this article states it well:
In an invited critique accompanying the report, Jana B.A. MacLeod, MD, of Emory University in Atlanta, agreed that risk adjustment is a better approach than the one taken by the Medicare system.
"This study provides an evidence base to discuss whether unconditional preventability of complications, even in the environment of evidence-based treatment guidelines, actually exists," MacLeod wrote.
"In our attempt to eliminate the avoidable, we cannot allow the public and private health care funding groups to punish us for the inescapable."
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Let’s just define any adverse reaction or complication as a ‘never event’ and be done with it.