麻豆传媒

Establishing a coordinated stroke center at a tertiary care community hospital did not increase the total direct and indirect costs of treating patients at one institution, researchers found.

The median total hospital cost was $12,812, and that did not significantly increase as the stroke program was enhanced over time, according to , of Saint Luke's Neuroscience Institute in Kansas City, Mo., and colleagues.

"The implication is that the increase in costs for personnel and technology was offset by improved efficiencies in process, although this analysis did not allow identification of the cost savings attributable to a specific change in process," they wrote in the August issue of Stroke: Journal of the American Heart Association.

"These results suggest that a comprehensive stroke care program with improved access, stroke care, and outcomes may be financially feasible for hospitals to implement," they added.

The impetus behind the establishment of a stroke program at Saint Luke's Hospital was the low usage of intravenous tissue plasminogen activator (tPA), which has been shown to improve outcomes when administered shortly after onset of an ischemic stroke.

In a previous study, Rymer and her colleagues found that the use of and patient outcomes significantly improved after formation of the .

To evaluate the financial aspect of setting up the system, the researchers retrospectively evaluated total hospital costs and payments from all payers for treating patients with ischemic stroke. The analysis included .

Overall, total hospital costs were lower in the current study compared with other published estimates. Costs varied in certain patient subgroups.

Among patients with acute ischemic stroke, for example, multivariate analysis revealed that total costs were significantly lower for:

• Patients 65 and older versus younger patients (by $1,883)
• Those with lower NIH Stroke Scale scores at baseline (by $103 per 1-unit decrease)
• Those with shorter hospital stays (by $1,705 per day)
• Those who did not receive intra-arterial tPA or embolectomy (by $9,727)
• Those who did not have reperfusion attempted (by $4,578)

In general, the stroke center lost money on a per-patient basis. Payments from all payers came in below the total hospital costs for all patients (by a median of $2,324), patients who received IV or intra-arterial tPA or embolectomy (by $3,220), and those in whom reperfusion was not attempted (by $2,186).

"Because tPA has been associated with improved clinical outcomes, it may be appropriate for Medicare and private insurers to assess the and modify reimbursements to incentivize treatment," Rymer and colleagues wrote.

"If evidence is established that intra-arterial tPA or embolectomy yields better outcomes in patients with large vessel occlusions, payment coverage should be even higher than intravenous tPA because this analysis noted that the financial losses were greater when intra-arterial tPA or embolectomy was used," they wrote.

They noted that after adjustment for inflation, payments to the hospital increased over time; the hospital received $8,918 more per patient in 2010 than in 2005.

Limitations of the analysis included the uncertain generalizability of the findings to other centers, the lack of randomized assignment to treatment or no reperfusion, the retrospective design, and the use of imputed values for indirect overhead costs.

From the American Heart Association:

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