The Centers for Medicare & Medicaid Services (CMS)

The Centers for Medicare & Medicaid Services (CMS) formed its no-pay policy based on the growing work of National Quality Forum (NQF) of “never events.” Meaning, CMS will no longer pay for certain conditions that result from what might be termed poor practice or events that should never have occurred while a patient was under the care of a healthcare professional.

Discuss specific examples of “never events” and their impact in your workplace.

What issues are you considering for your clinical project and why?

Essay: The CMS No-Pay Policy and “Never Events” in Clinical Practice

In an effort to improve patient safety and quality of care, the Centers for Medicare & Medicaid Services (CMS) implemented a no-pay policy in 2008 that significantly impacted healthcare delivery in the United States. This policy was shaped by the work of the National Quality Forum (NQF), which compiled a list of serious, preventable, and costly medical errors known as “never events.” These are adverse outcomes that should never occur in a healthcare setting when proper care is provided. The CMS policy refuses reimbursement for additional costs incurred as a result of these events, thereby holding healthcare facilities and providers more accountable and encouraging preventive strategies.

Examples of “Never Events” and Their Impact in the Workplace

“Never events” include a variety of serious errors that compromise patient safety. Examples include:

• Surgical errors such as wrong-site surgery or performing surgery on the wrong patient.

• Foreign objects left in the body after surgery, such as surgical sponges or instruments.

• Falls and trauma that occur in a healthcare facility, particularly those that lead to fractures or head injuries.

• Pressure ulcers (stage III or IV) acquired during the patient’s hospital stay.

• Catheter-associated urinary tract infections (CAUTIs) and central line-associated bloodstream infections (CLABSIs).

In my workplace—a busy acute care hospital—one notable impact of the no-pay policy has been increased vigilance in pressure ulcer prevention. Previously, pressure ulcers were sometimes viewed as an unfortunate but inevitable part of long-term patient care. Now, due to financial and quality penalties, prevention has become a high priority. This has led to the implementation of skin integrity rounds, more frequent patient repositioning, enhanced documentation, and staff education on early signs of pressure injury.

Similarly, fall prevention initiatives have been strengthened. Fall risk assessments are completed on admission and routinely updated. Interventions such as bed alarms, non-slip socks, and frequent rounding are now standard practice. These changes not only reduce the risk of CMS penalties but also improve patient outcomes and satisfaction.

Clinical Project Considerations

For my clinical project, I am considering focusing on reducing catheter-associated urinary tract infections (CAUTIs) in the inpatient setting. This issue is both clinically significant and financially impactful due to its classification as a “never event.” CAUTIs are often preventable through evidence-based practices, yet they remain among the most common healthcare-associated infections (HAIs).

My interest in this topic stems from observed inconsistencies in catheter care and documentation in my unit. Despite policies aimed at reducing indwelling catheter use, I’ve seen cases where catheters remained in place longer than medically necessary, increasing the risk of infection. Staff education, protocol adherence, and regular catheter necessity reviews could dramatically reduce the incidence of CAUTIs.

Addressing this issue aligns with broader hospital goals of improving quality metrics and reducing preventable harm. It also offers an opportunity to implement a sustainable, system-wide change that supports both CMS reimbursement standards and patient-centered care.

Conclusion

The CMS no-pay policy for “never events” represents a significant step toward accountability and quality improvement in healthcare. By targeting events that are avoidable with proper care, CMS has incentivized hospitals to adopt safer practices and foster a culture of prevention. As healthcare professionals, it is our responsibility to respond to these initiatives not just to meet policy standards, but to ensure that we are delivering the safest, highest-quality care to our patients. Projects aimed at reducing events like CAUTIs not only help meet CMS standards but, more importantly, protect the well-being and dignity of those we serve.