CMS measure to curb CT use 'unreliable'

A quality measure that the Centers for Medicare & Medicaid Services uses to assess appropriateness of imaging use is being called into question.

With careful attention to limit inappropriate use of CT scans and other imaging equipment, CMS developed OP-15, a measure to gauge which patients in hospital emergency departments should receive a CT scan and which shouldn't. CMS also plans on publishing data from measure OP-15 in Hospital Compare.

However, researchers in today's Annals of Emergency Medicine study found that the CMS rule designed to limit CT scans is "unreliable, invalid and inaccurate," according to the American College of Emergency Physicians (ACEP).

The measure was only 17 percent accurate in assessing which patients should receive a CT scan, according to lead study author Jeremiah Schuur of the department of emergency medicine at Boston's Brigham and Women's Hospital. Schuur noted that it could mean that Medicare will publicize "inaccurate information about clinical performance" and reward hospitals based on unreliable data.

Researchers looked at nearly 750 headache patients and found that 65 percent of the CT scans actually complied with Medicare's measure, and another 18 percent of patients had valid reasons for the CTs documented on their charts.

"This could have the unintended consequence of pressuring physicians not to order otherwise appropriate CT scans in order to bolster their hospitals' performance on the CMS measure," ACEP President David Seaberg said in a statement. "This has potential to put seniors--who are the most likely to have dangerous causes of headaches--at risk if serious conditions are missed."

The movement to curb inappropriate use stems not only from cutting costs but also from warnings about over-radiation. In August 2011, The Joint Commission issued a Sentinel Alert that warned healthcare organizations about the long-term risks to patients, encouraging them to implement "reasonable alternatives."

The number of CT scans has increased 330 percent from 1996 to 2007, according to another Annals of Emergency Medicine study.

For more information:
- read the ACEP press release
- check out the video of the ACEP President commenting on the study
- read the HealthImaging article

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