Comparative-effectiveness research offers an opportunity to evaluate government policy (Is the government ready to lead effectiveness panel? Feb. 23). Perhaps we can subject policies such as never event determinations to scientific review.
A recent Journal of the American Medical Association commentary presents an example of the unintended consequences of their policymaking. Deep-vein thrombosis after these procedures is biologically unavoidable, even with evidence-based therapy and patient compliance.
Clinicians and hospitals will avoid high-risk patients (obese) and this particular procedure all together. They could attempt to lower the likelihood of avoiding a venous thromboembolism, or VTE, event of excessive prophylaxis (with increased bleeding complications, which is not a never event). Finally, this policy affects only 8.6% of the currently recognized deep-vein thrombosis events post-discharge or procedure and does not set expectations for the other 93% of admissions at risk. The authors observe, The Joint Commission has recommended that hospitals adopt procedures to ensure that all patients receive risk-appropriate VTE prophylaxis within 24 hours of hospital admission or within 24 hours of transfer to the intensive-care unit.
It is the process, not the outcome, that can be the true measure in this case. The CMS policy should be subjected to the same comparative effectiveness standards as practicing clinicians. The CMS should lead by example.
R. Bruce Wellman, M.D.President and CEOCarle ClinicUrbana, Ill. Submit a letter to the Modern Physician Reader Blog. Please include your name, title, company and hometown. Modern Physician reserves the right to edit all submissions.