"If CMS wants to make decisions aimed at reducing use of technology in order to reduce spending of money, those decisions should be based on good science. But CMS is pretending that we already have a criteria we can use, and they're wrong," he says.
ACEP has other concerns: In an Aug. 30 letter, ACEP told CMS that "Because the guideline is for older adults, there is no scientific basis to suggest there is a patient safety issue – there is no evidence that a CT scan of the head increases the risk of cancer or other issues."
The letter added that the reporting requirement will use claims data, which doesn't include "important information in the patient chart justifying the scan." In ACEP's "dry run" of the rule at 20 hospitals in 12 states this May, 64% of those cases that CMS criteria would have labeled 'inappropriate' "had a measure exclusion documented in the medical chart that was missed in the administrative data."
Solomon says it's too early to tell how many patients will suffer harm their doctors were afraid to order a brain CT.
"But I can tell you that if you're the patient in the ED with a subarachnoid hemorrhage and you have permanent disability, your family is going to take a very dim view of CMS' guidelines," Solomon said.
Of course, there's a possibility that ED doctors will do the right thing, even if it makes their hospital look like it's guilty of overuse.
But Solomon thinks many physicians will hold back. "If I ordered a CT scan and it's normal, this is not going to be in compliance with the quality measure, and I'm going to be called to account for this and I'll undergo chart review.