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Medicare Payments for Stroke Care Not Keeping Up
with Costs
Feb. 17, 2006 - Medicare payments for ischemic
stroke treatment 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.
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“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.
Other co-authors are Charles Marotta, M.D., Ph.D.;
Jason Scharf, B.A.; Michael S. Mafilios, B.S.; Tyler Knight, M.S.; G.
David Parker, Ph.D. and Gregory P. Samsa, Ph.D. The pharmaceutical
firm AstraZeneca funded the study.
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