Never Event

A never event is a medical error so serious and so preventable that it should never happen: surgery on the wrong patient or the wrong body part, a sponge or instrument left inside someone, a fatal medication error, a patient given the wrong blood type, a serious injury from a fall in the hospital, a stage 3 or 4 pressure ulcer that developed during the stay. The National Quality Forum keeps the official list, now 29 items, and most states require hospitals to report them.

The financial side is clear and is often overlooked by the people paying the bills. Since 2008 Medicare has refused to pay hospitals for the extra cost of treating a hospital-acquired condition on its list, and most commercial plans and self-funded employers have written the same rule into their contracts and plan documents. Many hospitals, following the Leapfrog Group's "never events policy," also commit to apologize, report the event, and waive all charges related to it. Yet it still happens that a plan pays for a second operation to remove a retained sponge, or a family is billed for a pressure-ulcer treatment the hospital caused. Nationally, wrong-site surgery is estimated at around 40 cases a week, and retained surgical items at more than 1,500 a year. The rates vary by hospital, and they are among the measures inside the Leapfrog grade and the CMS star rating.

The takeaway: if you or a family member suffers a never event, the hospital should not be billing for the care it caused; ask for every related charge to be removed in writing. Employers reviewing claims should flag any hospital-acquired condition code and refuse the associated charges.