Help ACEP Fight Inappropriate CT Scan Measure

May 13, 2011

Despite arguments from ACEP and a rejection by the National Quality Forum (NQF), a measure of CT scan usage in the emergency department is still part of the Centers for Medicare and Medicaid Services’ Hospital Outpatient Quality Data Reporting Program beginning in 2012. ACEP is asking for your help during the current “dry run” of the measure by telling CMS that the measure is flawed as drafted.

Although ACEP applauds the serious concern around the use and overuse of CT scanning, we object to the proposed CMS measure, which calculates a utilization rate (cost) and does not measure the quality (appropriateness) of imaging.

ACEP finds that the CMS measure, “Use of Brain Computed Tomography in the ED for Atraumatic Headache (OP-15),” is not evidence-based, has not been tested for reliability and validity, does not measure efficiency but rather utilization, and inappropriately includes only the emergency department.

In a letter to CMS in August 2010 (page 4), ACEP Past President Dr. Angela Gardner pointed out the measure “failed to meet the consensus requirement as it was not recommended for endorsement by the NQF.” Dr. Jeremiah Schuur, a member of ACEP’s Quality and Performance Committee, has also drafted talking points that detail the concerns.

CMS is proceeding with the measure and is now conducting a “dry run” for participating hospitals. This link describes the process your hospital can use to see which patients failed to meet the quality measure (e.g. should not have been scanned). For example, some of our members reviewed their own hospital data and found more than 50% of the patients listed actually met the criteria. Further, more patients were clearly candidates for head CT (on anticoagulants). (A detailed template for data collection was developed by Dr. Schuur and available online.)

While CMS has statutory leeway to do this, ACEP believes this sets a bad precedent for using measures that fall outside of a broad consensus-based endorsement process.

ACEP is encouraging everyone in the emergency medicine community to work with your hospital administrators and review your data. Provide feedback through QualityNet urging CMS to remove this flawed measure from the outpatient set.

The deadline for comments is May 27.

ACEP is also considering additional options as CMS proceeds with the measure. If you have questions about how to gather your data or about the measure, please contact Angela Franklin, ACEP’s Quality Measures/HIT director.

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