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Medicare Rule May Discourage Brain CTs in ED

Cheryl Clark, for HealthLeaders Media, October 20, 2011

Medicare officials declined to discuss ACEP's objections, saying they'll be addressed in the final rule. But in reading the fine print, it's obvious the agency wants to contain these scans, which many published papers say are ordered far too often without medical need.  At between $775 and $2,775 each, the costs adds up.

Additionally, the agency refers to the growing safety concern with CT radiation doses much higher than those from X-rays.

According to one published paper, 2% of ED patients – 136 million visits a year at last count – have headache as their chief complaint. That can yield a lot of head CTs.

The language in CMS' proposed rule is more detailed.

ED physicians, "because of time constraints and lack of ED physician familiarity with headache presentation" have a "lower threshold for ordering neuroimaging for headache," the agency says.

"Because of this lower threshold, the measurement of the use of CT Brain in the ED for patients with a diagnosis of atraumatic headache can help to raise the awareness of the need for quality improvement on the appropriate use of CT brain imaging in the ED and, as a result, improve patient safety through reduction in unnecessary radiation exposure."

"Unnecessary or duplicative studies are inefficient and detrimental to the patient because CT exposes the patient to higher doses of radiation than conventional x-ray and increases the patient's risk for cancer," the agency's rule says.

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3 comments on "Medicare Rule May Discourage Brain CTs in ED"


Scott Stroming (10/22/2011 at 6:01 PM)
I would be happy to order fewer tests if the feds make it illegal to sue me

Steven Meyerson, MD (10/21/2011 at 12:49 AM)
There is solid evidence that brain CTs are of no value for patients with syncope who lack neurological signs or symptoms yet nearly all of them have a CT ordered. This applies to other neuro diagnostics ordered for syncope as well. This should be a target for eliminating unnecessary and harmful testing. It's not rationing. It's applying medical knowledge to overcome fear of being sued for not ordering a test - even if it has been proven to be useless.

W. C. Dandridge, Jr. M. D. MBA, FACS (10/20/2011 at 5:02 PM)
Well it's starting. Rationing of health care.