CMS Head CT and efficiency

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Anyone else read the article in the new EM News? Seems like a dangerous precedent to potentially penalize a provider for a negative CTH without protecting us from getting sued for missing a positive one. Also curious what that means with a negative CT and a negative LP in a r/o SAH--my default dx would be HA--etiology unclear. I guess I'll just have to make sure all of my headache patients fall before I CT them so that the dx can be Closed Head Injury instead. :rolleyes:

http://journals.lww.com/em-news/Ful...Matters__CMS_Measure_a_Train_Wreck_for.4.aspx

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Anyone else read the article in the new EM News? Seems like a dangerous precedent to potentially penalize a provider for a negative CTH without protecting us from getting sued for missing a positive one. Also curious what that means with a negative CT and a negative LP in a r/o SAH--my default dx would be HA--etiology unclear. I guess I'll just have to make sure all of my headache patients fall before I CT them so that the dx can be Closed Head Injury instead. :rolleyes:

http://journals.lww.com/em-news/Ful...Matters__CMS_Measure_a_Train_Wreck_for.4.aspx

Typical....kind of like when they said we shouldn't use propofol in the ED....glad that got changed.


Wook
 
saw that as wel and it infuriated me. do you have any links to the actual measure? I'd like to see how its actually worded. it's really terrible what's happening to medicine, or what's not happening to medicine... why can't we have physicians in the trenches help shape policy? Don't we know a lot of things from our experience that would help the entire healthcare system?
 
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another problem that would be solved if people were directly responsible for costs...but we can keep dreaming.
 
This is a way to cut how much they pay you, nothing else. "We'll pay for this head CT, but not that one.". For those of you that supported Obamacare and thought ER doctors would make more money...get used to the idea of seeing more patients, faster, for less money. Unless...doctors actually stand up and fight for their own rights.
 
This is not an advertisement, and I am not affiliated with this program except as a participant - just a quick disclaimer.

The Standard of Care Project is aiming to hear input from every emergency physician regarding their routine workups. This is a grassroots movement to protect our own field by defining what WE consider to be standard of care. If you haven't done so already, please check out the latest copy of Emergency Physicians Monthly.

I've never been a political activist, protester, or extreme politico, but after reading the CMS "efficiency plan" I think enough is enough. Ladies and Gentlemen - our specialty is ours to keep or lose. If we all just continue to clock in and clock out without making REAL steps to protect what we have worked hard for, it will be gone in 2 years. Yes - 2 years according to the Affordable Care Act (ACA). Write your congressmen. Copy the leaders of every national organization in your letter. Participate in every chance you can to contribute your knowledge to help prevent this broken system from being placed in the hands of those who know nothing about what we do.

We are Emergency Physicians. We make big decisions every day for other people, and we do it better than any other specialty. PLEASE - take the time, a small amount of time, to make a big decision for yourselves.
 
What if in the course of treatment of the chart we state: President Obama and US Congress consulted regarding need for head CT to evaluate etiology of severe headache in 82-year-old female on coumadin. Aforementioned parties deemed CT not standard of care and deemed CT head as inappropriate care. In the event that patient has acute subdural hematoma or intracranial hemorrhage, please forward all litigation to US Congress and White House.

Seriously, though, if a test is denied by Congress that would have diagnosed a severe life threatening condition, at what point does Congress or the President assume legal liability? If the actions of Congress or the President lead directly to a death or bad outcome, why should they be absolved from legal liability? Every member of Congress that voted for said measure and the President should be listed as co-defendants in the case.
 
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Seriously, though, if a test is denied by Congress that would have diagnosed a severe life threatening condition, at what point does Congress or the President assume legal liability? If the actions of Congress or the President lead directly to a death or bad outcome, why should they be absolved from legal liability? Every member of Congress that voted for said measure and the President should be listed as co-defendants in the case.

Heh, that would be great. We can dream, right?

But can you imagine the plaintiff attorney? "So you mean to tell me, doctor, that you didn't order this test which could have saved your patient's life because you were afraid of not being paid??"

Juries will love it. :rolleyes:
 
Or better yet, why don't we label everyone discharged from the ED with headache CT as inefficient taxpayers (if they actually pay taxes). For every "ding" they get as citizens, they have to pay higher taxes to support medicare. Maybe people will begin to see the ER as a place for "emergencies" again...
 
Oh just bend me over!

Stuff like this is the reason I have the user name I do. If a lawyer, congressman , senator, presidents child, wife, mother, father ever had a medical problem, the first place they would be is in an emergency department, and unfortunately, some poor bastard with MD/DO behind there name would have to sit there and smile, like everything is peachy....

I love my job, I just expect to be paid for my skills.... just like a lawyer.

RAGE
 
This is not an advertisement, and I am not affiliated with this program except as a participant - just a quick disclaimer.

The Standard of Care Project is aiming to hear input from every emergency physician regarding their routine workups. This is a grassroots movement to protect our own field by defining what WE consider to be standard of care. If you haven't done so already, please check out the latest copy of Emergency Physicians Monthly.

I've never been a political activist, protester, or extreme politico, but after reading the CMS "efficiency plan" I think enough is enough. Ladies and Gentlemen - our specialty is ours to keep or lose. If we all just continue to clock in and clock out without making REAL steps to protect what we have worked hard for, it will be gone in 2 years. Yes - 2 years according to the Affordable Care Act (ACA). Write your congressmen. Copy the leaders of every national organization in your letter. Participate in every chance you can to contribute your knowledge to help prevent this broken system from being placed in the hands of those who know nothing about what we do.

We are Emergency Physicians. We make big decisions every day for other people, and we do it better than any other specialty. PLEASE - take the time, a small amount of time, to make a big decision for yourselves.

Any idea which EM organization out there that are proactive about fighting this CMS efficiency plan? Being a resident, I don't have a whole lot of free time, bu I can donate my money to strengthen their voice in the political area.
 
For those interested, here is a link to the measure:

http://www.imagingmeasures.com/measureset2.html

Probably the most important part of that is:

Denominator Exclusions:
Claims with secondary diagnosis codes related to:
lumbar puncture,
dizziness, paresthesia,
lack of coordination,subarachnoid hemorrhage,
complicated or thunderclap headache
focal neurologic deficit
pregnancy
trauma
HIV
tumor/mass

So, it looks like as long as we're charting/diagnosing thoroughly, a lot of them will be excluded as most of us aren't actually ordering CTH on 23 year olds with typical migraine symptoms. The elderly anticoagulated patient doesn't seem to appear as an exclusion. Bummer.
 
I can forsee many patients with a secondary diagnosis of dizziness (what patient does not answer "yes" to dizziness on review of symptoms?) or "complicated headache".

The other exlusionary listed on that website was "imaging studies for ED patients admitted to the hospital".

So if your head CT is negative and shows no bleed, just admit the patient to the hospital to avoid getting dinged.
 
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Better do an LP if you're going to give 'em that diagnosis!
 
This is a classic example of how adding bureaucracy makes things difficult and ultimately, can hurt individuals.

Delusional people believe that we can perfect society by hedging up the laws with more and more rules, leading to a quagmire of inefficiency and paralytic red-tape. Ultimately, this is pure evil. In a pharasaical pursuit of rule-making, people miss the spirit of the law.

I just finished a PHENOMENAL book called The Death of Common Sense. It is rather one-noted, but it gives example after example of the utter nonsense that results from our modern American bureaucracy.

I know a couple who have desparately wanted a child for decades. A mother had just chosen them to adopt her child. Last week, she was in her early second trimester when she miscarried. They, of course, had their hopes dashed. A woman abandoned a new-born baby at our hospital. A pathologist, one of the OB-Gyns, and myself all know this family who wants a baby and approached the social worker to put a good word in for them. The pathologist went so far as to bring the family to the hospital to meet the baby and the social worker. The social worker charged him with a HIPAA violation.

This baby needs someone to love it. Three different physicians from your hospital approach you to let you know that they know a responsible, loving family that would be a perfect home for the child. What is the right thing to do? Fight with everything you have to place the child in that home. Instead, you notice that they have broken HIPAA and sensure the physician.

Would you rather have a world full of people like my pathologist, or would you rather live in a world dominated by people like my social worker?
 
Wow. That's nauseating.

There is nothing I enjoy less than, yet spend more time engaged in, than covering my ass. It sounds like your SW (a job requiring saintliness if ever there was one) was covering his/her ass rather than working towards a greater good... problem is that CYA behavior is self-propagating and the alternative is self-defeating.
 
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