CMS metric may prompt excessive antibiotic use

Pressed to measure up in public reports, physicians at one hospital may have been too quick to diagnose patients with pneumonia, researchers say.

By Kevin B. O'Reilly, AMNews staff. March 17, 2008.

A new study says physicians are 39% more likely to misdiagnose hospital patients as having community-acquired pneumonia due to the high-stakes environment fostered by mandatory public reporting of quality measures -- in this case, whether pneumonia patients got antibiotics within four hours of arriving at the hospital.

The results, published in the Feb. 25 Archives of Internal Medicine, are similar to those found in a Chest study published last year and echo many physicians' complaints about the measure of initial antibiotic timing, known as door-to-needle time. A February 2007 Infection Control and Hospital Epidemiology study tied excessive use of antibiotics encouraged by the performance metric to a severe outbreak of Clostridium difficile at a small rural hospital.

The performance measure is part of the Joint Commission's and the Centers for Medicare & Medicaid Services' hospital quality reporting initiatives and was first rolled out in 2004. It represented a change from the earlier goal of getting antibiotics to hospital patients with community-acquired pneumonia within eight hours of arrival.

CMS said that beginning this month, it will not report hospitals' results on the four-hour antibiotic timing metric and report performance on a new, six-hour goal. The change still must go through the federal rule-making process.

How performance metrics drive changes in medical practice raises a larger question, experts say, about how best to balance the benefits of public reporting against the potential for negative unintended consequences.