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?

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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 3 on the topic of malpractice and CT use: 

Discuss some of the important differences between the current health care systems and medical malpractice environments in Canada and the United States. How might these differences affect CT use in the emergency department (ED)? How might the implementation of the Patient Protection and Affordable Care Act in the US affect these differences?

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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 2 on the topic of estimation on CT counts:

Do you think the National Hospital Ambulatory Medical Care Survey (NHAMCS) method is likely to overcount or undercount CTs? What about the method used for calculating use in Ontario? Would these biases likely make the authors’ estimate of the overall difference between these countries too large or too small? Defend your answer.

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