How CMS Penalizes Hospitals for Finding Blood Clots

Cheryl Clark, October 10, 2013

When it comes to blood clots in surgical patients, "vigilant hospitals get penalized because [when] they look more, they find more. Their rankings look atrocious," says the author of a report blasting a patient safety measure that he says is driving unintended consequences.

Karl Bilimoria

Karl Bilimoria, MD, Northwestern University Feinberg School of Medicine

Quality leaders at 227 hospitals that according to Medicare data have "worse than U.S. national rates" for serious blood clots in their surgical patients" might have a plausible defense this week.

That's because a research paper in an influential medical journal has blasted PSI-12—a patient safety initiative that tracks preventable venous thromboembolism (VTE) such as deep vein thrombosis and pulmonary embolism—for being Exhibit A for the law of the unintended consequence.

Many of the hospitals with high rates look bad, not because they truly are; quite the opposite. They look bad because they're diligently looking for blood clots harder than other hospitals, and thus they are finding more often.

The "worse-than" label applied by the Centers for Medicare & Medicaid Services doesn't necessarily mean these hospitals are providing poorer quality care, or failing to safeguard their patients, the authors say.

"The problem is that not everyone looks for blood clots in the same way; not everyone is as vigilant," explains Karl Bilimoria, MD, director of Northwestern University's Surgical Outcomes and Quality Improvement Center at the Feinberg School of Medicine in Chicago and author of this week's report in theJournal of the American Medical Association.

"The vigilant hospitals get penalized because they look more, they find more, and their rankings look atrocious, and that's why this measure really is unfair," he says.

At least two unintended consequences are encouraged by this measure, he says.


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