“The unintended consequences of preventing patient falls”

Falls are considered “never events” under Medicare guidelines and of course are the subject of litigation against hospitals and other providers. The costs of overreaction to fear of being charged with error are not so readily measured, but are only too real:

If hospitals are scrutinized for the occurrence of falls, the natural tendency will be to focus on such events even at the expense of competing (and perhaps more important) outcomes. Unintended consequences are likely to include a decrease in mobility and a resurgence in the use of physical restraints in a misguided effort to prevent fall-related injuries.

[New England Journal of Medicine via KevinMD]


  • “Never events” are just part of the nanny state of perfection that some people seem to think will usher in the coming of Christ’s return. “Never events” in effect say that if this event happens it is malice on the part of the hospital and does not recognize that we live in a world where a fall or an infection may occur despite best practices on the part of the hospital or employees. This is also another way the Federal govt can get out of paying for these things that will occur and in effect limit or ration the money for payment for these medical services. The patient is the one to suffer because the hospital is having to pay for this, leaving less money to pay for indigent patients, salaries, upkeep and all of the other attendant expenses associated with running a hospital. Yet, this belief by Congress and its allies have been held for years, witness Congress’s belief that controlling medicare costs by reducing the amount paid for services to hospitals and physicians why ignoring the cost of inflation and increase in salaries and other costs. Its all about money and not about patient care. In the words of that great philosopher, G. Marx: “If you think this place is bad off now, wait until I get through with it.”

  • Falls are considered “never events” under Medicare guidelines

    Did Congress just repeal the Law of Gravity?

  • Yes, Congress can do anything it wants, whether it violates gravity, economics, law of thermodynamics, and just basic criminal law.

  • As far as I know, Medicare is simply saying it will not pay to fix a problem caused by a “Never Event”. Not that the “Never Event” should never happen.
    Sort of like if I take my car to the shop to get an oil change, and they accidentally crack my windshield, I don’t expect to be billed for fixing it. It can happen, I just don’t want to pay for their mistake.
    Seems perfectly logical. Well, maybe they should call it “Don’t-Bill-Us-For-Your-Mistakes-Event” and there will less of a hue and cry about it.

  • All incentive plans work; just be prepared for the predictable outcomes.

    Since accidental asphyxia, a rare result of the use of physical restraints for patients, is not a never-event then economically driven rational actors will increase their use. Not because anyone is malevolent, but because one cannot consume their energies pitting real world judgement against the mindless machine of bureaucracy.

  • My point was that who should pay for “never events”? It seems a misnomer to call them that. What medicare is saying, we just wont pay for this, pay for it yourself. A form of rationing of payment for medical care. Accidental or not, it still something that must be paid for by someone. If it was an accident, then why should not medicaid pay for it? No one is saying that there should not be standards of care, but this is accidental, not reckless. People get infections, people fall, why should not medicaid pay for those accidents. Pure rationing, that is all.

  • BK,
    Let’s clarify your analogy. Let’s say that you took your 80 year old car in for a routine oil change. This is a car that has been used and yes probably abused for 80 years. It has visible signs of 80 years of constant use. Exposure to the enviroment, hot and freezing temperatures, visible signs of cracks, chips and defects in the windshield. The oil change is uneventful, but while parking your car in the lot a bird shits on your windshield and it shatters. Do you still hold the auto shop responsible?

  • Why, then nobody should pay for the removal of the bird crap off the car. Perhaps the car owner should pay for it himself. The auto body shop should not, and neither should the hospital. So, I guess if medicare is not going to pay for the “never event”, then the hospital should not have to pay for it either. That leaves the “owner” of the body to pay for it.

  • The never-event policy is dumb. Lets presume that hospital staffs are aware of the frailty of old people so that falls are random events like fender-bender car accidents. Then hospitals will have the expected costs of falls as part of its overhead which should be covered by medicare payments. It is true that the hospitals would have an economic incentive to minimize falls, but such minimization would occur through common decency. Besides, old people with broken bones can be very annoying.

    I really dislike policies of holding hospital staff (or teachers) feet to the fire. Isn’t CPSIA a feet-to-fire policy for toy makers and others?