This article is more than 5 years old. Information may no longer be current.
New VTE quality measures is endorsed by NQF for voluntary hospital data collection
CMS adds measures to pay for reporting lists, non-compliant hospitals lose 2% of payment updates.
Click Here to Manage Email Alerts
A recent National Quality Forum endorsement of two venous thromboembolism quality measures has led to voluntary hospital reporting on the management of the condition.
While a new rule by the Centers for Medicare and Medicaid Services (CMS) includes these measures in a list that hospitals use to receive full annual payment updates, controversy exists regarding which venous thromboembolism (VTE) prophylaxis protocols have been approved.
The two measures, developed under the Surgical Care Improvement Project (SCIP), detail the proportion of patients with recommended VTE prophylaxis ordered and the number of patients who have the prophylaxis administered 24 hours before surgery or after procedures. As National Quality Forum (NQF)-endorsed measures, hospitals can voluntarily submit data regarding these measures on CMS’ publicly reported Web site, www.hospitalcompare.hhs.gov.
Fully endorsed
|
“The measures are out, they are fully endorsed now and they are in place in data collection tools for discharges that started in October of this year,” Dale Bratzler, DO, MPH, co-chair of the NQF’s VTE Prevention and Care Technical Advisory Panel, told Orthopedics Today.
He noted that a new CMS rule, release Nov. 1, adds the measures to a “pay-for-reporting” list starting in 2007. The list includes measures that hospitals report on to receive full annual payment updates. While reporting on these measures is not mandatory, centers that do not will lose 2% of their update, Bratzler said.
The fact that CMS has added these measures to its list will not greatly impact orthopedic surgeons, Vincent Pellegrini, Jr, MD, also a member of the VTE Prevention and Care Technical Advisory Panel, told Orthopedics Today. Rather, the concern will be which prophylaxis methods are endorsed.
“What the orthopedic community has every right to be proud of is that as a specialty orthopedists are ahead of the curve in terms of their knowledge of, appreciation for and recognition of the need for prophylaxis,” Pellegrini said. “Where the controversy exists for the orthopedic community is exactly which prophylaxis is felt to be most appropriate.”
While the endorsed measures are based on the American College of Chest Physicians (ACCP) guidelines, Pellegrini said that some question the appropriateness of these recommendations for orthopedics.
White paper
|
Pellegrini said that he and the American Academy of Orthopedic Surgeons (AAOS) are working to develop a white paper to help determine which prophylactic methods should be instituted.
The paper will include information from level 1 studies as well as observational reports.
“One of the problems in terms of the Chest Physicians guidelines is that, in choosing only prospective randomized controlled trials as those papers that they were going to reference, it biases the papers they’re going to look at since those are very expensive trials to run,” Pellegrini said. “ … there are several well-designed observational studies that look at natural history as well as response to prophylaxis that are not randomized prospective control that also tell us some things.” He anticipates that the AAOS will submit the white paper by next summer.
Bratzler said that the maintenance process of the measures is dynamic. “If evidence changes, if guidelines change, then we will revise the performance measure,” he said. “We meet with national experts on venous thromboembolism all the time and we do continuously revise the measures so they’re actually updated every 6 months.”
Pellegrini said that goal is a happy medium, which will balance the risk of VTE with the risk of bleeding.
“We know that VTE has been a very emotional disease,” he said. “It’s surrounded by a lot of religious beliefs and so we need to eliminate the religious beliefs and have data driven protocols. The challenge to date is that when only randomized prospective trials are the ones that people look at to drive the guidelines, we miss part of what also works.”
For more information:
- www.qualityforum.org
- Dr. Pellegrini is the chair of the department of orthopedics at the University of Maryland School of Medicine, 22 South Greene Street, Suite S11B, Baltimore, MD 21201. He can be contacted at 410-328-6040, fax: 410-328-0534 or vpellegrini@umoa.umma.edu.
- Dale Bratzler, Do, MPH, is the QIOSC medical director, 1400 Quail Springs Parkway, Suite 400, Oklahoma City, OK 73134. He can be contacted at 405-840-2891, fax: 405-840-1343 or dbratzler@okqio.sdps.org.