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The CMS Ruling on Venous Thromboembolism After Total Knee or Hip Arthroplasty

The CMS Ruling on Venous Thromboembolism After Total Knee or Hip Arthroplasty COMMENTARY The CMS Ruling on Venous Thromboembolism After Total Knee or Hip Arthroplasty Weighing Risks and Benefits quency of these events in routine clinical care because clinical Michael B. Streiff, MD trial participants are typically healthier than general orthope- Elliott R. Haut, MD dic patient populations. The Table outlines the detailed exclu- sion criteria that were used to select participants in the most N AUGUST 2008, THE US CENTERS FOR MEDICARE&MED- recently published double-blind RCTs of VTE prophylaxis for icaid Services (CMS) added deep venous thrombosis and TKAorTHA.Reviewofthesestudiessuggeststhatitisunlikely pulmonary embolism after total knee arthroplasty (TKA) thattheresultsobtainedinpublishedclinicaltrialswillbeachiev- Iand total hip arthroplasty (THA) to the list of never ableinreal-worldclinicalsettings.HigherratesofVTEandma- events. If a patient experiences deep venous thrombosis or jor bleeding complications are more likely to occur at tertiary pulmonary embolism following one of these procedures, a care academic medical centers, where high-risk patients tend portion of the payment made by CMS to hospitals is to be to be preferentially referred. Consequently, these institutions, withheld. On the surface this decision seems to be a win- whichoftenalreadyprovideadisproportionateamountofmedi- win for hospitals, clinicians, and patients. Venous throm- cal care to needy and uninsured patients in the United States, boembolism (VTE) is a common cause of http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png JAMA American Medical Association

The CMS Ruling on Venous Thromboembolism After Total Knee or Hip Arthroplasty

Streiff, Michael B.; Haut, Elliott R.
JAMA , Volume 301 (10) – Mar 11, 2009
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References (17)

Publisher
American Medical Association
Copyright
Copyright 2009 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.
ISSN
0098-7484
eISSN
1538-3598
DOI
10.1001/jama.301.10.1063
pmid
19278950
Publisher site
See Article on Publisher Site

Abstract

COMMENTARY The CMS Ruling on Venous Thromboembolism After Total Knee or Hip Arthroplasty Weighing Risks and Benefits quency of these events in routine clinical care because clinical Michael B. Streiff, MD trial participants are typically healthier than general orthope- Elliott R. Haut, MD dic patient populations. The Table outlines the detailed exclu- sion criteria that were used to select participants in the most N AUGUST 2008, THE US CENTERS FOR MEDICARE&MED- recently published double-blind RCTs of VTE prophylaxis for icaid Services (CMS) added deep venous thrombosis and TKAorTHA.Reviewofthesestudiessuggeststhatitisunlikely pulmonary embolism after total knee arthroplasty (TKA) thattheresultsobtainedinpublishedclinicaltrialswillbeachiev- Iand total hip arthroplasty (THA) to the list of never ableinreal-worldclinicalsettings.HigherratesofVTEandma- events. If a patient experiences deep venous thrombosis or jor bleeding complications are more likely to occur at tertiary pulmonary embolism following one of these procedures, a care academic medical centers, where high-risk patients tend portion of the payment made by CMS to hospitals is to be to be preferentially referred. Consequently, these institutions, withheld. On the surface this decision seems to be a win- whichoftenalreadyprovideadisproportionateamountofmedi- win for hospitals, clinicians, and patients. Venous throm- cal care to needy and uninsured patients in the United States, boembolism (VTE) is a common cause of

Journal

JAMA – American Medical Association

Published: Mar 11, 2009

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