The Wisdom and Justice of Not Paying for “Preventable Complications”

• Published in: JAMA : the journal of the American Medical Association Vol. 299; no. 18; pp. 2197 - 2199
• Main Authors: Pronovost, Peter J, Goeschel, Christine A, Wachter, Robert M
• Format: Journal Article
• Language: English
• Published: United States American Medical Association 14.05.2008
• Subjects: Centers for Medicare and Medicaid Services (U.S.); Disease; Economics, Hospital; Humans; Medical errors; Medical Errors - economics; Medical Errors - prevention & control; Patient Discharge - statistics & numerical data; Patient safety; Payments; Postoperative Complications - economics; Postoperative Complications - prevention & control; Prevention programs; Quality of care; Quality of Health Care - economics; Quality of Health Care - standards; Reimbursement, Incentive; United States; United States
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.299.18.2197

Centers for Medicare & Medicaid Services (CMS) has published that conditions being considered for 2009 expansion of the list include ventilator-associated pneumonia, Staphylococcus aureus septicemia, and deep venous thrombosis or pulmonary embolism. The tacit assumption to the "not paid for preventable complications" approach is that an error occurred in a patient's care that, if avoided, would have prevented the harm and ensuing costs. For one complication on the CMS list, foreign objects inadvertently left in patients after surgery, this is undeniably true. Linking errors to harm for the remaining complications is more complex. For strategies built around the "not paid for preventable complications" concept to be clinically and morally acceptable and to achieve the policy goal of improving quality of care, it must be certain that preventable complications are important and measurable and truly are preventable. Here, Pronovost et al discuss the CMS initiative in the context of these metrics.