Medicare Payments for Stroke Care Not Keeping Pace with Costs

Medicare Payments and Stroke

Medicare payments for ischemic stroke treatment and preventive stroke surgery are lagging behind the costs, which may imperil stroke care in the future, according to research reported today at the American Stroke Association's International Stroke Conference 2006.

"Without adequate reimbursement for these cases, it may be hard for hospitals to adopt new technologies such as intravenous thrombolysis and other therapies that may be in development to treat stroke," said study co-author David Matchar, M.D., professor of medicine at Duke University in Durham, N.C. and director of the Duke Center for Clinical Health Policy Research.

About 700,000 Americans suffer a new or recurrent stroke each year and about 157,000 of them die. Ischemic strokes account for 88 percent of all U.S. strokes.

About 72 percent of acute stroke patients are Medicare beneficiaries. Under Medicare's Diagnosis Related Groups (DRGs) reimbursement system, the agency pays a fixed price for a specific ailment or procedure. Many commercial health insurers follow Medicare's lead in setting their payment rates.

Researchers used data from the Medicare Provider Analysis and Review (MedPAR) database, a public file of statistical information on the inpatient hospitalizations of Medicare beneficiaries.

The study examined whether Medicare's reimbursement for standard treatment of ischemic stroke posed a financial barrier to the introduction of new stroke therapies. Ischemic stroke is caused by a blockage of an artery in or leading to the brain.

"Standard treatment of stroke includes supportive care and therapy for prevention of complications such as pneumonia, deep vein thrombosis and recurrent stroke. In selected patients, standard therapy includes tPA," Matchar said.

Researchers analyzed 351,239 Medicare claims filed under the three International Classification of Diseases (ICD-9-CM) codes 433, 434 and 436 from fiscal year 2002 to identify cases included in the analysis of the costs of treatment of acute ischemic strokes. Hospital cost-to-charge ratios were used to estimate costs and then inflated to fiscal year 2005 dollars.

"With an average Medicare reimbursement of $6,589, hospitals lost an average of $2,100 to $3,700 for treating stroke," said lead author Thomas Goss, Pharm.D., Vice President for Consulting Services at Covance Market Access Services, Inc., in Gaithersburg, Md.

The researchers calculated that patients' hospital stays would have to be slashed almost in half to bring standard stroke care costs in line with Medicare's reimbursement.

"To reduce costs by further decreasing length of stays appears inconsistent with current standards for stroke care," Goss said.