Articles of interest: Elimination of the Autopsy Requirement by CMS

Rueckert J. Elimination of the Autopsy Requirement by CMS. N Engl J Med. 2020 Feb 13;382(7):683-684.

Full-text for Emory users.

The autopsy plays a vital role in quality assurance by providing education and feedback to clinicians regarding diagnostic accuracy, therapeutic efficacy, and medical complications. At our institution, we promote a culture of transparency. Discrepant cases are discussed with the treating physicians and families and are also presented at conferences on morbidity and mortality, to educate a broad audience. As is the case at other academic institutions, our autopsy service provides extensive support of cutting-edge research efforts and hence is not “obsolete.”

CMS is making a mistake. A robust autopsy service plays an important role in providing and maintaining high-quality patient care. By eliminating the autopsy requirement, we are burying opportunities for improvement. The autopsy should be supported, not undermined.


Goldman L. Autopsy 2018: Still Necessary, Even if Occasionally Not Sufficient. Circulation. 2018 Jun 19;137(25):2686-2688.

Full-text for Emory users.

Autopsies continue to find class 1 errors for which antemortem diagnosis would have led to a treatment that would have prolonged life in ≈9% of autopsies in US hospitals, and a 100% autopsy US rate could find ≈28 000 class 1 misdiagnoses, a >10-fold increase in comparison with current practices. Our collective inability to address the financial and medicolegal disincentives to higher autopsy rates is a societal shortcoming, undoubtedly reinforced by overconfidence in modern diagnostic technology.

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