In This Issue...

NQF Updates Reportable, Preventable Errors

On December 20, 2011, the National Quality Forum (NQF), a leading voluntary consensus –setting organization, released a report, “Serious Reportable Events in Healthcare -- a 2011 Update,” which identifies 29 preventable medical errors that should be monitored and reported by health care providers. According to NQF, “more than 2 million health care-acquired conditions are responsible for 90,000 deaths and approximately $5.7 billion in added health care costs.”

Since 2002, NQF has updated its list of performance indicators annually. This year, the group added four new serious reporting events (SREs), including one involving laboratory tests:

  • Patient death or serious injury resulting from failure to follow up or communicate laboratory, pathology, or radiology test results.

“The Committee agreed on the importance of this newly submitted event and acknowledged that the issue of failure to follow up or communicate imposes significant risk of death or serious injury (e.g., change in stage of cancer). With continued discussion, the event was modified to limit its scope to those areas from which critical information in the form of test results most often come, with an expectation that it could be expanded in future updates.”

Among the eight proposed new SREs not recommended for endorsement this year (but expected to be “included in future updates as experience and the evidence evolves”) is another involving laboratory testing: “Diagnostic testing error resulting in unnecessary invasive procedure, serious disability, or death.” GAU will continue to report on future developments involving these indicators.

A copy of the full report is available on the NQF Web site.

HHS OIG Study Indicates Hospitals Not Reporting Adverse Events

The Department of Health and Human Services (HHS) Office of the Inspective General (OIG) released a study on Thursday, January 5th, entitled, “Hospital Incident Reporting Systems Do Not Capture Most Patient Harm,” which revealed that hospital staff are not reporting 86 percent of adverse events to their incident reporting systems. The OIG acknowledges, however, that a key problem is that many staff members are unclear as to what constitutes patient harm and consequently, requires reporting. The study urges the Agency for Healthcare Research and Quality and the Centers for Medicare and Medicaid Services to create a list of potentially reportable events and provide it to hospitals. If you would like to read the entire report, it is available on the HHS OIG web site.

CMS Issues Q&A Document on New Medicaid RAC Rule

In December 2011, the Centers for Medicare and Medicaid Services (CMS) posted a Frequently Asked Questions document on its Web site to explain how it plans to implement its new Recovery Audit Contractor (RAC) program for Medicaid. Currently this program, which hires private contractors to review provider claims to determine whether the government has over- or under-paid them, is limited to Medicare. The 2010 health care reform law expanded this initiative to Medicaid. The new Medicaid RAC initiative took effect as of January 1st.

Among the key points in the 18-page document are:

  • RACS will only focus on fee-for-service claims;
  • States are not required to publicize in advance the areas where RACS will focus their attention;
  • RACS are limited to reviewing 300 records per audit hospital inpatient claims;
  • States have the discretion to determine what areas are audited; and
  • RACS cannot review claims that are more than three years old from the date claims were filed.