ALiEM Journal Club Question 4: Reimbursement Tied to Diagnosis

For the ALiEM – Annals of EM global journal club on the article “Emergency Department Computed Tomography Utilization in the United States and Canada”, discuss question number 4 on the topic of reimbursements tied to diagnosis:

The Centers for Medicare & Medicaid Services (CMS) proposed instituting a new process metric OP 15 “Use of Brain CT in the Emergency Department of Atraumatic Headache.” OP 15 measures the percentage of ED visits for atraumatic headache (ie, ED billing codes for tension, cluster, migraine, and nonspecific headaches) among Medicare beneficiaries who have a brain CT performed on the same day. ED patients who are admitted to the hospital and those whose secondary diagnoses include codes related to subarachnoid hemorrhage, transient cerebral ischemia, and tumor/mass are excluded from the denominator. The public reporting of OP 15 is presently postponed to allow time for refinement of the measure by a technical expert panel. However, if this indicator is fully instituted, would the threat of decreased reimbursement and public reporting of use decrease your ordering of CTs in patients older than 65 years and with atraumatic headaches?

PDF of article
PDF of entire list of Annals journal club questions