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Medicare Rule May Discourage Brain CTs in ED

Cheryl Clark, for HealthLeaders Media, October 20, 2011

Elsewhere, the agency referenced a 2007 report in The New England Journal of Medicinethat of 62 million CT scans performed per year (including those of the brain) "a third are unnecessary, resulting in patient safety issues including unnecessary radiation and contrast material exposure, and the danger associated with 'false positive' findings.' "

Yes, ACEP's leaders say, they know doctors order too many CT scans. But to start requiring that they be counted in QDRP, published on HospitalCompare and to use this data to reject or adjust Medicare claims, is just way too premature, Solomon says.

It even goes against the Affordable Care Act, which say that CMS' quality measures must be set forth by one or more national consensus building entities, such as the National Quality Forum, ACEP says.

That would be great if already happened, Solomon says. But it hasn't.

The proposed rule deals with that by saying "We anticipate that (the measures) will be endorsed by the NQF."

Solomon says brain CT is a huge dilemma for ED doctors because the scans rarely reveal clinically significant findings, but when they do, they're really important. But science has not developed a clinical decision-making tool that would help them "be more judicious."

"It'd be nice if a well-designed, big study found five or six symptoms that – if the atraumatic headache patient does not have – will indicate they won't have anything serious and you can refrain from doing the CT," he explains. But such a tool does not yet exist.

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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.