More On Medicare Never Events


I have to stop reading Kevin’s blog.

Lately, every time I read through his posts, I get all riled up over something. The most recent thing to get my blood boiling was Kevin’s link to a nice rant on Buckeye Surgeon’s blog about these looming Medicare “Never Events.” There’s a journalist in Cleveland named Diane Suchetka who published a “blind leading the blind” article about “never events” in the Health News section of

I know that I’ve beaten this whole “never event” horse before, but the whole concept is just so remarkably brain dead that I had to get my whip out again.

The thing that concerns me the most about the “never event” concept right now is that many members of the general public are jumping on this bandwagon. Like foie gras ducks being force-fed corn, the citizens of this country are being force fed the notion of “never events” by the government and insurance agencies. Even more disconcerting is that the feeble minded among us actually believe that all of these “never events” should never happen. Just look at the comments to Ms. Suchetka’s article.

After reading the article and the comments, I added my own comment:

It is unfortunate that someone so misinformed about the effects of “never events” on the practice and accessibility to medical care is allowed to publish an article like this. It is even more unfortunate that so many of the members of the general public support Ms. Suchetka’s ramblings.
First of all, look at the contradictions contained within this article itself. She quotes someone from “SHIC” as saying that “If hospitals were to set up efforts to follow these longstanding practices, the vast majority of these medical errors and infections could be prevented.” Wait a second. “Vast majority?” I thought that these were “never events.” Shouldn’t Captain Obvious have stated that the events would “never” happen if the policies were followed?
Medicare calls the “errors” “reasonably preventable.” If they are “never events,” shouldn’t they be called “entirely preventable”? If they are “never events” then I want to see the people who came up with that term treat patients for a year and show me their results in preventing them.
There are other misstatements. Realitynurse states that “C. diff is a medical mistake.” Uninformed and untrue statement. C. diff is an organism that lives and grows just like every other organism on this planet. Antibiotic use may increase the prevalence of C. diff, but antibiotic use does not “cause” C. diff. Your statement is akin to saying “mosquitoes are a mistake” or “uninformed nurses are a mistake.”
Why has C. difficile become so ominous? Up to 20% of people prescribed clindamycin can develop C. difficile. What exactly should we do to make sure that not one single patient ever develops a C. difficile infection? Go on. I want all you smart people to tell me. Stop prescribing all antibiotics? Sounds like a plan. Then Medicare will deem all the other infections as “never events,” too.
If any of the people reading this column want to avoid never events, here’s how to do it: Don’t go to doctors and stay away from hospitals. That’s right. Boycott us. If you want to create a manual on how to provide perfect medical care while you’re treating yourself for a ruptured appendix, I’d be happy to read it.
Ms. Suchetka is right that these Medicare rules will affect all of us, but she has the wrong reasoning. They will affect all of you that develop these conditions because physicians and hospitals will avoid you like the plague. If you are prone to falling, good luck finding a doctor to treat you. Immunocompromised and likely to develop infections? Better read up on those medical journals. You’ll be treating yourself soon.
“Medicaid expenses could drop”? Get a clue. They won’t drop, they’ll increase. No one will accept Medicaid patients with predispositions to these conditions and the patients will end up in the emergency department where the care is really inexpensive. Maybe Medicaid should focus its efforts on reigning in those that misuse their access to health care in order to score some pain meds. That would save a lot more money than this all this hogwash about those things that are and are not preventable.
Hospitals are “get[ting]the message” alright. They’re closing. Doctors are getting the message, too. Fewer and fewer specialists are treating patients from emergency departments because they don’t want to deal with people who expect perfection and who then try to sue when they don’t get it.
When your local hospital closes down or when the wait for care is so long that you or a loved one develop a bad outcome because of it, you can thank people like Ms. Suchetka for putting pablum to paper.
Boy am I glad I’m a doctor.

The comments on the blog have to be approved by the blog owner and at this point Ms. Suchetka or whoever “owns” the blog has still not “approved” my comment about her uninformed article.

I just decided that I’m not finished yet. Now you’re getting both barrels, lady.

A DVT will soon be a never event. Indirectly what CMS is saying is that blood should never clot. If blood should never clot, then why doesn’t CMS make Coumadin ingestion mandatory for every person in the United States? We’ll just put rat poison in the water supply and force everyone to go for their monthly INR checks. Oh, wait – maybe it’s only that blood should “never” clot in the legs. Where do I get my own set of government-issued Ted Hose? And another thing – all you airlines better give me upgrades to first class or I’m not paying for my flights. What’s fair for medicine is fair for the travel industry. “Never” means never.

C. difficile and Staph aureus infections are also going to be considered “never events.” Think about the idiocy of this classification. Mircoorganisms should “never” happen. You sonofabitches in the government give us a vaccine to eradicate smallpox but you’re holding out on the C. diff vaccines so you can avoid paying for medical care, aren’t you? How long before strep throat, otitis media, pneumonia, H. pylori gastritis, and urinary tract infections will also be never events? Ooops. UTIs already are never events. Don’t forget about tooth decay, either. Stinking peptostreptococcus bugs. Oh yeah – yeast infections, too. Monistat will soon be mandatory for all women. The human body should be absolutely sterile.

“Never events” are and always have been “all about the Benjamins.” Look at this news release. The “background” section states that the “never events” were “required” pursuant to Section 5001(c) of the Deficit Reduction Act. Medicare wants to stop paying for things not because they “should never happen” but because it’s trying to save money. The whole “never event” moniker is just a spin they put on the cuts to make it look like someone else’s fault. Do “never events” never occur at government run hospitals? We’ll never know because CMS doesn’t even include government run hospitals on the “hospital compare” list.

Am I the only one that finds it odd that CMS is so willing to judge others but is so unwilling to allow others to judge it?

Just like the guy that cuts your lawn, your attorney, or any other entity that performs services for you – once you stop paying for the services, you stop getting the services. Medical care will be no different. Economic forces will make it more and more difficult to find care if you are predisposed to a “never event.”

In addition, medical providers will find loopholes in the “never event” system that will drive up the costs of care instead of decreasing it. Maybe your doctor will transfer you to another hospital for “specialist care” after you develop a “never event” so that the new hospital can bill for it. Maybe you’ll suddenly develop some other medical condition that the hospital can bill for while you are treated for the uncompensated “never event.” Trust me – medical providers are a helluva lot more creative than the people working at the Medicare National Bank.

Rest assured that whatever happens, the laws of unintended consequences will increase the costs of treating “never events” and Medicare’s inevitable decline into bankruptcy will occur even more quickly because of it.

Other countries must just be watching us, smirking, and shaking their heads.

Get your healthcare while you can. If you still believe that never events should never occur, you better get your treatment for delirium quickly – delirium is one of the conditions on the “never event” hit list.

Picture credit here

P.S. I’m still glad that I’m a doctor.



  1. Never events sound weird. It makes me glad I live in Canada and never have to contend with such nonsense. My view is shit happens. Not everything in life is preventable all the time if at all. If anybody suggested such a never event thing up in Canada the Canadian press would have hay day writing articles mocking the idea.

  2. Yes, the Marie Antoinette of bureaucrats has let loose the “Let them eat cake!” edict. Based on little or no research that any of these reduce morbidity or mortality or that they actually will reduce these events from occurring, they are now in place by edict alone. Not trialed in certain centers to see if their deaths were reduced, not studied elsewhere to see if they can be cost-effectively carried out.

    They are just methods to not pay hospitals. Period. No appeals, no rebuttal to the charges.

    More of the health insurance rules game where they can make up any rule they want when it fits their particular whim, especially if it gets them out of paying providers.

    So, my patients, you will be protected so much and not held accountable for anything that might happen to you, even by act of nature, that soon there will be no hospital left and no providers left to care for you.

    Then the government will force us providers to provide care even past the point of bankruptcy (like Chicago is trying to do).

    Let the punishment continue until morale improves!!

  3. What is the general feeling about “sentinel events”? Ar! My personal sentinel event went *unreported* by nursing staff and doctors (to their own administration). When I brought the great-sucking-sound-derived-from-my-life’s-quality-dancing-’round-the-flushing-toilet-bowl to the attention of the state, I began hearing these “event” terms being tossed about so blithely. Truly, a straightforward approach to errors, with apologies and clear explanations being offered immediately, would eliminate all sorts of crap — but the medical industry, the insurance industry, and the legal industry all would need to stop betting on the lowest common human denominators. This is what I think of while I don’t sleep at night. But when an “event”(and an event is not an error) is but a microbe taking its rightful advantage? Well, I wonder what these righteous folk shall be like when faced with a real problem. Ach. I’m tired.

  4. Well by now we should all realize that medicare considers us to be ‘civil servants’ without all the benefits of the FEBHP, vacations, disabilty coverage, etc and a four day work week.

    P.S. I have had great success posting comments of the WSJ Health blog…don’t know about their other sections. It also has an RSS feed.

    Health Train Express

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  7. Of course these rules are designed to reduce payments to providers. Any government run healthcare system (including, but not limited to Medicare) must, and always will have to ration care. However, it is politically risky for elected officials to admit this. Therefore, to cover their tracks, they ration care by restricting payment, knowing that without payment, the care cannot be provided (you can’t get something for nothing). Your observation that it will now be harder for the sickest patients (the ones who need the physician’s services the most) will receive less care is not a threat to the policy makers; it is confirmation that they are achieving their desired results.

    When the government pays the bills, your body becomes a piece of state property, to be treated or abandoned as the state deems most efficient. Just look at Brittan, where earlier this year the government quietly promulgated a regulation that any deceased person’s organs can be used for transplantation, even if neither the person from whom those organs are being harvested, nor their family, have consented to this. It makes sense, really. After all, the National Health Service has provided the medical care that kept those organs alive from cradle to grave, so why shouldn’t the state have the authority to take possession of the bodies of its citizens when the state decides to.

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