ICD-9 Code-Based Venous Thromboembolism Performance Targets Fail to Measure Up. (September 2016)

• Record Type: Journal Article
• Authors: Lau, Brandyn D.; Haut, Elliott R.; Hobson, Deborah B.; Kraus, Peggy S.; Maritim, Chepkorir; Austin, J. Matthew; Shermock, Kenneth M.; Maheshwari, Bhunesh; Allen, Paul X.; Almario, Aileen; Streiff, Michael B.
• Is Part Of: American journal of medical quality. Volume 31:Number 5(2016:Sep./Oct.)
• Page Start: 448
• Page End: 453
• Publication Date: 2016-09
• Subjects: venous thromboembolism -- pay for performance -- quality improvement -- ICD-9; Medical care -- Quality control -- Periodicals; Medical care -- Evaluation -- Periodicals; Medical care -- Utilization review -- Periodicals; Medical care -- United States -- Periodicals; 362.1
• DOI: 10.1177/1062860615583547
• Languages: English
• ISSNs: 1062-8606

Abstract

Venous thromboembolism (VTE) is a common complication among hospitalized patients. Suboptimal prevention practices have prompted payers to consider hospital-associated VTE as a potentially preventable condition for which financial incentives or penalties exist to drive practice improvement. The authors reviewed all cases of hospital-associated VTE at the Johns Hopkins Hospital between July 1, 2010, and June 30, 2011, that were identified by ICD-9 codes used by a state-run pay-for-performance quality improvement program. Of 157 patients identified as having developed hospital-associated, potentially preventable VTE, only 92 (58.6%) patients developed radiographically confirmed VTE that were potentially preventable. This misclassification of VTE overestimates the marginal additional treatment cost by more than $860 000 and amounts to nearly $200 000 in lost reward in one year alone. ICD-9 codes alone have extremely low positive predictive value to identify true VTE events. The authors recommend linking provision of risk-appropriate prophylaxis to VTE outcomes as a better target for performance improvement.