The CMS Ruling on Venous Thromboembolism After Total Knee or Hip Arthroplasty: Weighing Risks and Benefits

In August 2008, the US Centers for Medicare & Medicaid Services (CMS) added deep venous thrombosis and pulmonary embolism after total knee arthroplasty (TKA) and total hip arthroplasty (THA) to the list of never events.¹ If a patient experiences deep venous thrombosis or pulmonary embolism following one of these procedures, a portion of the payment made by CMS to hospitals is to be withheld. On the surface this decision seems to be a win-win for hospitals, clinicians, and patients. Venous thromboembolism (VTE) is a common cause of preventable harm,² yet many hospitalized patients fail to receive adequate VTE prophylaxis.³ Accordingly, the strategy of using financial incentives to encourage better performance should result in fewer thrombotic events and consequently less morbidity and mortality related to VTE and its treatment.