The case for redefining "never events" for hospitals

When is it acceptable for a hospital to send debt collectors after low-income patients? The answer should be "never," argues a new article published in JAMA Health Forum.

Why it matters: Health systems around the country — particularly nonprofits — have come under fire in recent years for aggressively pursuing debt collections, and even suing, patients who can't pay their bills.

• At least 40% of Americans surveyed earlier this year said they struggled to pay medical bills or were paying off medical debt, according to The Commonwealth Fund.

The big picture: The authors framed the issue using the National Quality Forum's "never events" framework that came out 20 years ago. That defined patient safety events, like leaving a sponge inside a patient, as events that should "never" happen.

• "How do we take something that's routine, something that's considered a necessary harm or cost of doing business, and change it to something that's no longer accepted?" Adam Beckman of Harvard Medical School and a co-author of the report told Axios.
• He pointed to one recent instance reported by the New York Times about the 21-hospital non-profit Providence hiring debt collectors to pursue patients who should have qualified for free care.

Between the lines: Other proposed "never events" at hospitals, they said, should include not falling short on community benefit spending, never paying their employees less than a living wage, never flouting price transparency laws and avoiding racially segregated care.

Yes, but: This comes at a time when hospitals of all stripes have been reporting financial hardship caused by the pandemic. The authors acknowledge those challenges but said that's why clarifying principles are needed.

• They've also received suggestions for other "never events," they said, including that hospitals should "never" disrespect medical trainees or refuse to take Medicaid patients.