CMS Measurement for Brain CT Scans Unreliable, Misleading

A CMS quality measurement for use of CT scans on emergency department patients with atraumatic headaches is not reliable, according to a study published online in the Annals of Emergency Medicine. The measurements could lead to inaccurate comparisons of imaging performance in the ED.

CT scans on patients with atraumatic headaches is increasing in EDs around the country, which has raised concerns about rising costs and exposure to radiation. To determine if the testing was appropriate, the CMS developed measure OP-15, “Use of Brain Computed Tomography in the Emergency Department for Atraumatic Headache.” However, OP-15, which was implemented in January 2012, was never field tested.

To determine the measurement’s accuracy, researchers at Brigham and Women’s Hospital in Boston, Mass., completed a retrospective record review of 748 patients, gathered from 21 EDs in the U.S., who were labeled as receiving inappropriate brain scans.

The researchers found that 83 percent of the patients who were identified as inappropriately tested actually were validly scanned; 65 percent of the scans did comply with the measures and 18 percent should not have been labeled this way to begin with.

“The CMS imaging efficacy measurement for brain CTs (OP-15) is not reliable, valid or accurate, and may produce misleading information about hospital emergency department performance,” the authors concluded.

The researchers acknowledged that while this measurement is not effective, everyone must work together to ensure proper the use of CT scans in the ED.

“Further research should focus on developing scientific evidence that could be used to better inform this measure,” said Ali Raja, MD, associate director for trauma, BWH Department of Emergency Medicine, and a co-author of the study. “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 an similar conditions.”