Expansion of CMS Never Events:  They’re Not Just For Medicare Or Just For Hospitals Anymore

In 2005 when “Never Events” were proposed for hospitals through the Deficit Reduction Act, no one knew what the overall effect would be on hospitals or patient care.  CMS later developed these and implemented these Never Events under the authority of the DRA to prevent Medicare payment to hospitals for certain “never events” or hospital acquired conditions (HACs) which were conditions that were high volume, involved higher payment, and which could be easily preventable.  Now, hospitals and other health care providers have to worry about Never Events in the Medicaid space. 

It is not too early for nursing facilities to plan for success under the Patient Protection and Affordable Care Act.  Hospitals under financial pressure to prevent readmissions and manage post-acute care services will be seeking “preferred providers” of nursing facility and home care services.  Those providers who know how to manage key conditions and demonstrate a low hospital readmission rate will be in the best position to win contracts with hospitals and accountable care organizations (ACOs).  There may also be opportunities to share risk for bundled post-acute care services. 

The following are steps nursing facilities should be taking now:

• Identify the right hospital partner that is geographically close and well positioned to bid for bundled services or to become an ACO. 
• Implement Electronic Health Records that are interoperable with the hospital’s and its physicians.
• Make sure you have physicians from the hospital practicing in your facility.
• Modernize your physical plant.
• Develop a great rehabilitation program.
• Enhance clinical capabilities by developing outcome-driven care pathways.
• Select a medical director who specializes in nursing facility care.
• Get set up to perform procedures on site.
• Work to make certain the transition from hospital to nursing facility is seamless.
• If you will be sharing risk, get to know your costs.

Nursing facilities that contract for post-acute care services will eventually require 24/7 physician or nurse practitioner coverage and 24 hour RN’s.  You can expect your post-acute care patients and families to be more educated and more demanding.  Customer-centered services will become the norm.

With the emphasis on pay for performance, nursing facility stays may be shorter but market share will be higher.  Meanwhile, with Medicaid squeezing rates, the most successful facilities will want to continue to maximize their Medicare participation.