Medicare Ends Iatrogenic Pneumothorax During CVC Reimbursements
Medicare No Longer Covers Costs of Iatrogenic Pneumothorax During CVC: Signals Major Shift in Recognition of Ultrasound Needle Guidance Efficacy
The Centers for Medicare and Medicaid Services (CMS) has announced that, effective October 1, Medicare will no longer reimburse hospitals for the extra costs associated with pneumothorax complications when they occur during central venous catheterization procedures.
This ruling is significant on many fronts. For the first time ever, we have a CMS hospital measure that can be directly impacted by point-of-care ultrasound. By taking this step, Medicare acknowledges that pneumothoraces during central line placements can be greatly reduced and even eliminated by using ultrasound needle guidance. Numerous studies have demonstrated this, and institutions like Memorial Hermann have proven such in real-world conditions by keeping its cases of iatrogenic pneumothorax at zero for a full year in six of its hospitals and eight of their emergency departments.
In fact, under some circumstance, the central line can be avoided altogether (and, hence, the complications) by increasing the success rate of peripheral IVs by using ultrasound guidance for patients with difficult intravenous access. A study conducted by Thomas Jefferson University found that, by using ultrasound guidance for peripheral IVs, physicians were able to avoid placing central lines in 85% of the patients included in the study. (Au AK, et al. Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters. Am J Emerg Med 2012.)
By adding iatrogenic pneumothorax to its hospital-acquired condition (HAC) list, Medicare is also alerting hospitals that, in the coming years, they will risk the loss of additional funding if their HAC rates are high, and the financial impact could be significant.
Simply put: There's no longer any excuse for clinicians to injure patients while placing central lines virtually blind when easily obtainable ultrasound technology enables them to "see" where they're going.
Last fall, SonoSite engaged the Health Management Academy (HMA) to conduct a study regarding point-of-care (POC) ultrasound adoption within U.S. health systems. The organization discovered that only 25% of health systems had made a system-wide decision regarding its adoption. I anticipate that Medicare's ruling will serve as the tipping point for many hospitals to make their decision in favor of POC ultrasound. Furthermore, the addition of iatrogenic pneumothorax during CVCs to Medicare's HAC list could be seen by many medical centers as the proverbial handwriting on the wall regarding other complications that could be avoided by using ultrasound guidance.
October 1, 2012, should go down as a day of celebration for those who have advocated so tirelessly for the medical establishment's recognition of ultrasound-guided line placement benefits. And for those of us who continue to evangelize for more acceptance of ultrasound's broader clinical applications, we hope we'll be able to look back on this date as the day the "great shift" began.
Learn more about reducing iatrogenic pneumothorax complications during central line placements.