And there's lack of agreement on which blood clots are truly preventable, no matter what intervention is used. Many physicians just don't think their patients are at high risk, even if they meet the profile, while others overestimate the risk of bleeding when blood-thinning medications are used, he says.
There's a lack of uniformity on how long high-risk patients should be tracked and given medication. Should intervention stop at discharge, or should patients be on medication for 30 days, when post-discharge blood clots are most likely to form, or for as long as 90 days?
You'd think this would be a higher priority and that more progress would have been made, especially since Medicare in 2008 stopped reimbursing hospitals for extra care resulting from PEs after hip and knee surgeries, and Medicaid has recently followed suit.
You'd think there'd be greater incentives to weigh cost issues more seriously, as hospitals look at bundled or accountable care payment models. But hospital and federal health officials urge patience. Improvement is on the way.
Three efforts are underway to better quantify the problem and reduce VTE in healthcare settings.
1. The first is being launched by CDC, which a year ago launched a collaborative project to standardize how hospitals might report VTE cases to the agency's National Healthcare Safety Network. The idea is to create a model much like the CDC's system for tracking central line bloodstream and urinary tract infections, and ventilator-associated pneumonia.