Medicare Rule May Discourage Brain CTs in ED

Headache patients who come to the ED could die or become permanently disabled for lack of a brain CT to detect hemorrhage or tumors, all because of a new Medicare quality rule poised to take effect Jan. 1.

That may sound overly dramatic. But anger over the coming rule echoed through many sessions of the American College of Emergency Physicians scientific assembly in San Francisco this week.  

Robert C. Solomon, MD, a member of ACEP's board and a member of the faculty in the emergency medicine residency program at Allegheny General Hospital in Pittsburgh, is one doctor who insists that death and permanent disability are exactly what will happen if the proposed rule takes effect. 

Without a CT, aneurysms that should be surgically repaired will go unseen, he says.  Subtle bleeds will go undetected. "Patients are going to suffer harm as a result of this," he told me in an interview. 

Starting Jan. 1, the Centers for Medicare & Medicaid Services wants to apply the Quality Data Reporting Program to cover orders of brain CT on beneficiaries whose chief complaint is headache in the absence of an obvious traumatic event.

Exclusions would apply for patients with dizziness, paresthesia, lack of coordination, subarachnoid hemorrhage or abrupt onset "thunderclap" headaches, those who undergo lumbar punctures, or those admitted or transferred to an acute care hospital. 

CMS's final rule is expected in the next two weeks. Eventually, ACEP officials say, hospital scores will determine Medicare payment adjustments, up or down, because that has been the CMS' stated goal.

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