The American College of Emergency Physicians has raised red flags over proposed measures aimed at CT scan usage in the emergency department and patient radiation dose exposure.

One measure is proposed by the Centers for Medicare and Medicaid Services (CMS), OP-15 – Use of Brain Computed Tomography in the ED for Atraumatic Headache. Additionally, the Patient Radiation Dose Optimization Performance Measurement Set is intended for use in physician maintenance of certification programs. Both measures have generated “deep concerns” from ACEP.

ACEP has applauded the serious consideration given to the use and overuse of CT scanning, as well as efforts to reduce radiation exposure and health costs. But the College cautions that there is the potential for missed diagnoses resulting from fewer scans. ACEP strongly urges modifications or removal of these measures as written from the proposed sets.

“We used to miss brain bleeds, but now with CT scans we find them before they kill or paralyze,” said ACEP President Dr. Sandra Schneider. “My high school best friend nearly died from a subarachnoid hemorrhage and was left with paralysis and difficulty speaking for the past 25 years. I don’t want to miss patients we might save from similar disability.”

“This measure, if it moves forward, will turn back the clock to those terrible old days,” she said. “If we get this measure rescinded, lives will be saved – I really mean that.”

CMS has included of the CT scan measure OP-15 in its Hospital Outpatient Quality Data Reporting Program (HOP QDRP).

ACEP objects to this measure because it is not evidence based, is simply a raw “utilization” measure that will not improve patient outcomes, and could increase missed diagnoses in the emergency department as physicians are pressured against administering the CT scans.

The measure, which also could hold physicians liable for any bad outcomes, is scheduled for hospital reporting, with payment implications beginning October 2012.

ACEP supports the use of a broad consensus-based process to vet measures that hold physicians and hospitals accountable for improving patient care. ACEP objected to the CT scan measure as it was being considered at the National Quality Forum (NQF), a multistakeholder, consensus-based endorser of quality measures in the field.

During the NQF process, ACEP objected to the measure because it does not follow published guidelines for care and will not produce reliable and valid results about the quality of care when implemented. ACEP wrote that “without high quality evidence to guide appropriateness decisions, a measure comparing use of CTs between institutions is a utilization measure rather than an efficiency measure.”