Waimei Tai, MD

As previously whispered and predicted, CMS recently announced that they are piloting evaluation of new claims-based measures that address 30-day Stroke readmissions and mortality starting August 12, 2013.

The plan of course, is not only to improve the quality of care we provide our stroke patients, but also to potentially adjust payment for performance, as the other CMS core measures have done for MI, heart failure, pneumonia, and surgical outcomes.

Here’s what the Stroke Measures will look like:

STK-1 VTE Prophy
STK-2 Discharged on Antithrombitc Therapy
STK-3 Anticoagulation for Afib and Aflutter
STK-4 Thrombolytic Therapy
STK-5 Antithrombotic Therapy By End of Hospital Day 2
STK-6 Discharged on Statin
STK-8 Stroke Education
 STK-10 Assessed for Rehab

Does this look familiar? Why yes, they are incredibly similiar to what many hospitals already do for  TJC (formerly JCAHO) has metrics for those that are designated primary stroke centers or comprehensive stroke centers. This designation is voluntary for hospitals, but since many counties do EMS diversion, this designation is important for the hospitals to capture and serve those patients.

Similarly, the American Heart Association has a voluntary participation program (like they do for heart attack and CHF) for Get with the Guidelines in Stroke with process metrics.

Anyways, so what’s all this fuss about?

I guess even though CMS claims they will case-mix adjust these metrics, I’m a bit hesitant to think that meeting these metrics will ensure patients will get the best stroke care. I’m all about decreasing variation and providing best value care (hence I’m a CERC fellow) but I’m not sure if these metrics really reflect differences in quality.

A few weeks ago I had a patient with a hypercoagulable state secondary to metastatic cancer who we discharged home on anticoagulation as the clinical science dictates. I got a reminder email from our quality auditor asking why she didn’t get a statin at discharge (as our Comprehensive Stroke Center designation would have us monitor for). Well, I should have done a better job documenting that her abnormal liver function tests from her metastatic cancer would have precluded use of a statin. And no evidence for statin use exists in this type of patient. But I don’t think CMS will read that deeply. Without my documentation correction, we would have been dinged for that metric.