Head CT utilization

[throckmortonDO]

---

Members don't see this ad.

So recently our hospital system has been aggressive about HCT 'utilization' in both peds and adults. The 'numbers' were brought to our attention at the last quarterly meeting. Most people are in the middle with a few outliers.

I wasn't aware of a CMS measure of utilization of HCT specifically but I suppose it is factoring in to cost equations for the hospital, although I was under the impression that 'advanced imaging' increased RVU's.

I tend to heavily use Canadian HCT/C-spine/Nexus/PECARN etc, so I am not an outlier, and can definitely see the utility in peds specifically. In adults not so much - too many elderly MVC's and intox/polysubstance/assault/trauma, for it to really seem like it would make a difference in our population.

Just wondering if this is yet another way to potentially separate us from revenue or if there is some national criteria pending/CMS measure i haven't yet heard of?

also, how does this factor into large Lvl 1 centers where pan scan is deeply rooted?

 

[southerndoc]

CMS will use your MIPS performance to adjust your future payments. Perform poorly with MIPS (formerly PQRS) this year, and your reimbursements for either 2019 or 2020 will be reduced. I can't remember when exactly they start the reductions, and who knows if it gets changed someway before it happens.

Every month we get a chart that shows the average number of CT's we order per 100 patients. It's graphed out by month with the facility average and the health system average. Like you, I'm also very aggressive with Canadian rules. Most docs don't realize the rules were designed for those who lost consciousness. They think that losing consciousness means the rules can't be applied and they get a CT. Not so.

At any rate, my average is around 50-55 per 100 patients. Working in a busy level II trauma and comprehensive stroke center, many patients get multiple CT's. A pan scan on a trauma is 5 CT's (head=1, cervical/thoracic/lumbar spine=3, chest/abdomen/pelvis=1). A stroke patient that gets a CT, CTA, and CT perfusion is 3 CT's. You can see where they add up quickly. Given that we almost never see level 4's (handled almost exclusively by the APP's), our numbers can get quite high. I've had months where I've been >75 CT's per 100 patients.

CMS has been measuring head CT's for a while. Other things that CMS tracks for MIPS: topical antibiotics for otitis externa (give them oral and it's counted against you), antibiotics for pharyngitis without a positive Strep screen (so long Centor criteria), avoidance of antibiotics in bronchitis (unless complicated, but must specify what makes it complicated), ultrasound determination of pregnancy for pregnant patients with abdominal pain, assessment of Rh status (or documentation of its assessment) in early pregnant patients, antibiotics for sinusitis, etc. Some of these are on their way out and will be replaced by other measures soon.

 

[BoardingDoc]

assessment of Rh status (or documentation of its assessment) in early pregnant patients,

Wait, what? There is some metric out there which says we are supposed to figure out the Rh status of all early pregnant patients in the ED, regardless of complaint? Vaginal bleeding, sure. But say, headache? Cough? Why the hell would you type these women?

 

[southerndoc]

Wait, what? There is some metric out there which says we are supposed to figure out the Rh status of all early pregnant patients in the ED, regardless of complaint? Vaginal bleeding, sure. But say, headache? Cough? Why the hell would you type these women?

No, sorry. Didn't mean to confuse you. It's only for vaginal bleeding, abdominal pain, and blunt abdominal trauma. Not for bronchitis. :O Sorry!

This measure is to be reported each time a pregnant patient presents to the emergency department with complaints including blunt abdominal trauma, vaginal bleeding, ectopic pregnancy, and threatened or spontaneous abortion.

 

[AlmostAnMD]

It's only for vaginal bleeding, abdominal pain, and blunt abdominal trauma. Not for bronchitis. :O Sorry!

yet