Medicare shortchanges hospitals on stroke therapy

Treating stroke patients with clot-busting drugs costs U.S. hospitals substantially more than Medicare pays, a new study finds.

The results are potentially concerning, researchers say, because in the long run, some hospitals may get out of the business of treating strokes.

People suffering a stroke caused by a blood clot - which most strokes are - can be treated with an IV medication called tissue plasminogen activator (tPA). As long as the drug is given within three hours of the first stroke symptoms, it can break up the blood clot and help limit brain damage from the stroke.

For the new study, reported in the journal Stroke, researchers looked at the cost of hospitalizing patients treated with tPA versus what Medicare paid out.

They found that between 2001 and 2008, it typically cost U.S. hospitals $14,100 (in 2008 dollars) to care for a tPA patient who had a "good outcome." If the patient suffered serious complications from the stroke or died, the typical cost was around $19,000.

But the average Medicare payment for patients with a good outcome was $10,000, and just over $13,800 for patients who had disabling strokes.

Background and Purpose-It is important to know the costs for hospitalization for ischemic stroke patients treated with intravenous thrombolysis so that comparisons can be made with payments to hospitals.

Methods-Using the National Inpatient Sample, we evaluated hospitalization costs for patients treated with intravenous thrombolysis for acute ischemic stroke in the United States from 2001 to 2008. Cost data were correlated with demographics and clinical outcome.

In an earlier study, the same researchers had found that hospitals generally lose money on Medicare reimbursements for another stroke treatment - endovascular embolectomy, in which doctors go in and extract the blood clot causing the stroke.

"Some people had said hospitals might make it up with reimbursements for patients who get IV thrombolysis," said senior researcher Dr. Harry J. Cloft, referring to the clot-busting drug treatment.

But based on these latest findings, that's not the case, said Cloft, of the Mayo Clinic in Rochester, Minnesota.

In an interview, he noted that none of this means you should be worried that if you were taken to the hospital with a stroke tomorrow, they might not give you tPA because it's too pricey.

But over the long term, some hospitals might decide they don't want to invest in being stroke treatment centers.

"It could affect availability (of tPA) if some hospitals lose interest in treating a disease they are losing money on," Cloft said.

The American Hospital Association declined to comment for this story.