Analysis of Centers for Medicaid and Medicare Services ‘Never Events’ in Elderly Patients Undergoing Bowel Operations

Since October 2008, the Centers for Medicare and Medicaid Services (CMS) has denied reimbursement for 10 hospital-acquired “never events,” which were deemed reasonably preventable. This study compares the frequency and costs of CMS “never events” in patients undergoing bowel operations between ages 65 to 79 years and 80 years or older. Patients aged 65 years or older who underwent small or large bowel operations, from January 2008 to March 2009, were identified by a retrospective review of inpatient charts and the Greenville Hospital System electronic coding database. Outcomes included hospital length of stay (LOS), discharge status, incidence of “never events,” and median hospital costs determined by the EPSi cost system. Of 151 patients identified, 118 were age 65 to 79 years old and 33 were 80 years or older. A total of 90 CMS “never events” was found in 64 patients. The most common conditions were surgical site, catheter-related urinary tract, and vascular catheter infections. Patients 80 years of age or older had a statistically higher incidence when compared with the age 65- to 79-year-old age group of catheter-related urinary tract infections (UTIs) (36 vs 12%), vascular catheter infections (15 vs 4%), hospital LOS (11 vs 6 days) as well as a greater median hospital cost ($28,300 vs $15,300). It is unclear whether these “never events” are the reason for higher costs or an indicator of more severely ill patients. Nevertheless, it is clear that the additional financial burden of caring for these high-risk, high-cost, elderly patients is clearly borne by the hospital.