Administrative Never Events Cause Subtle but Real Patient Harm

October 28th, 2022

By Jill Drachenberg, Editor, Relias Media

“Administrative never events” are just as harmful to patients as medical never events, according to the authors of a recent editorial. Policies such as aggressive debt collection and lack of equitable care can cause additional harm to patients when they should be focusing on recovery.

“Hospitals should be places for healing, not agents of harm — and there is precedent for addressing harm in hospitals,” the authors wrote. “Now, another category of hospital behaviors should be rendered unacceptable — a different set of never events.”

The authors noted these five administrative never events that can harm patients and employees:

• Aggressive debt collection, such as wage garnishment and lawsuits;
• Spending less on community benefit and charitable care than is earned in tax breaks from nonprofit status;
• Noncompliance with federal price transparency regulations;
• Paying hospital employees less than a living wage;
• Failing to provide racially inclusive and equitable care.

These administrative never events cause subtle but real harm to patients, the report authors argue. Seventeen out of 20 hospitals highly ranked for safety and quality in U.S. News and World Report only scored a C or lower on the equity metric. Sixty percent of nonprofit hospitals spent less than two cents on charity care for every dollar of revenue. A large healthcare system reportedly hired debt collectors to pursue patients who should have received charity care. “It is now possible for a hospital to provide one patient a free taxi ride to overcome transportation barriers and simultaneously sue another patient for medical debt,” the authors noted. “Hospitals’ first responsibility should be to stop creating social harms.”

Policies should be created to reduce these never events, the authors argued. These include payment adjustments from the Centers for Medicare & Medicaid Services, similar to payment adjustments for patient safety scores. State legislatures also could require reporting of harmful policies and incentivize hospitals to change.

“These actions can occur alongside efforts to fix the nation’s antiquated health care reimbursement system, as reforming the incentive structures causing hospitals to maximize revenue at the expense of patients is the ideal long-term solution,” the authors concluded.