Medicare and Medicaid CT scan measure is unreliable: study

February 23, 2012, Brigham and Women's Hospital

Researchers at Brigham and Women's Hospital (BWH) have published findings that question the reliability of a new Centers for Medicare and Medicaid Services (CMS) quality measure. The study, "Assessment of Medicare's Imaging Efficiency Measure for Emergency Department Patients With Atraumatic Headache" finds that the CMS measure—an attempt to reduce computed tomography (CT) scans in emergency departments (ED)—does not accurately determine which hospitals are performing CT scans inappropriately.

The study is electronically published in the February 23, 2012 issue of Annals of Emergency Medicine.

With the recent surge of CT use in EDs, comes concern about radiation exposure and cost. CMS developed measure OP-15, "Use of Brain Computed Tomography in the Emergency Department for Atraumatic Headache," to evaluate the use of brain CT in the ED for atraumatic in order to improve imaging efficiency. The measure was implemented into the Outpatient Prospective Payment System in January 2012 but was never field-tested.

Jeremiah Schuur, MD, BWH Department of Emergency Medicine, and colleagues at 21 EDs in the United States studied the , validity, and accuracy of measure OP-15. The measure uses Medicare billing records to determine whether a CT was clinically appropriate.

The researchers compared the data reliability of the measure as obtained from CMS administrative data against data from ED medical records. They reviewed 748 patient visits that CMS labeled as having undergone inappropriate brain CTs based on billing data. However, when the patients' medical records were reviewed, they showed that the bills didn't tell the whole story; the researchers discovered that 65 percent of the CT scans actually complied with Medicare's measure and another 18 percent of patients had valid reasons for the CTs documented on their charts. Overall, 83 percent of the patients should not have been labeled as having been inappropriately imaged.

This led researchers to conclude that CMS measure OP-15 may lead to inaccurate comparisons of EDs' imaging performance.

"It is important for physicians, hospitals and payers to work together to develop systems that ensure that every CT that is performed is appropriate," said Schuur. "Our research finds that OP-15 may not be a valid measure of imaging in elders and that when calculated from claims, can produce unreliable data."

"Further research should focus on developing scientific evidence that could be used to better inform this measure," added Ali Raja, MD, associate director for trauma, BWH Department of Emergency Medicine, and study co-author. According to Raja, "existing guidelines built around solid evidence for the appropriate use of CT for other clinical conditions could serve as a guide for the measurement of these and similar conditions."

Explore further: Use of CT scans in emergency rooms increased 330 percent in 12 years

Related Stories

Use of CT scans in emergency rooms increased 330 percent in 12 years

August 10, 2011
A review of national data from 1996 through 2007 reveals a sharp uptick in the use of computed tomography, or CT, scans to diagnose illnesses in emergency departments, a University of Michigan Health System study finds. The ...

Minority children less likely to receive CT scans following head trauma

October 14, 2011
African-American and Hispanic children are less likely to receive a cranial computed tomography (CT) scan in an emergency department (ED) following minor head trauma than white children, according to an abstract presented ...

CT scans for dizziness in the ER: Worth the cost?

January 26, 2012
Performing CT scans in the emergency department for patients experiencing dizziness may not be worth the expense – an important finding from Henry Ford Hospital researchers as hospitals across the country look for ways ...

Large study finds CT scans are frequently unnecessary after head injury in children

May 9, 2011
Overall, roughly half of U.S. children taken to hospital emergency departments (EDs) for a head injury receive a head CT scan, often to ease worried parents' concerns. Yet true traumatic brain injury is uncommon. A multi-center ...

Experts offer pointers for optimizing radiation dose in head CT

August 1, 2011
An article in the August issue of the Journal of the American College of Radiology summarizes methods for radiation dose optimization in head computed tomography (CT) scans. Head CT is the second most commonly performed ...

Recommended for you

How cancer metastasis happens: Researchers reveal a key mechanism

January 18, 2018
Cancer metastasis, the migration of cells from a primary tumor to form distant tumors in the body, can be triggered by a chronic leakage of DNA within tumor cells, according to a team led by Weill Cornell Medicine and Memorial ...

Modular gene enhancer promotes leukemia and regulates effectiveness of chemotherapy

January 18, 2018
Every day, billions of new blood cells are generated in the bone marrow. The gene Myc is known to play an important role in this process, and is also known to play a role in cancer. Scientists from the German Cancer Research ...

These foods may up your odds for colon cancer

January 18, 2018
(HealthDay)—Chowing down on red meat, white bread and sugar-laden drinks might increase your long-term risk of colon cancer, a new study suggests.

The pill lowers ovarian cancer risk, even for smokers

January 18, 2018
(HealthDay)—It's known that use of the birth control pill is tied to lower odds for ovarian cancer, but new research shows the benefit extends to smokers or women who are obese.

Researchers develop swallowable test to detect pre-cancerous Barrett's esophagus

January 17, 2018
Investigators at Case Western Reserve University School of Medicine and University Hospitals Cleveland Medical Center have developed a simple, swallowable test for early detection of Barrett's esophagus that offers promise ...

Scientists zoom in to watch DNA code being read

January 17, 2018
Scientists have unveiled incredible images of how the DNA code is read and interpreted—revealing new detail about one of the fundamental processes of life.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.