The Centers for Medicare and Medicaid Services published today a new code that will reimburse hospitals for the use of tissue plasminogen activator, an effective thrombolytic. The shift will help hospitals recoup thousands of dollars lost each year from treating stroke patients.
Available CMS codes pay hospitals a flat rate of about $4000 to $6000 per acute ischemic stroke case, regardless of whether thrombolytics are used. The dose of tPA required for one intervention, however, costs about $2000. The drug's high cost has hampered its use.
Diagnosis Related Group code DRG 559 will reimburse hospitals at the rate of $11,578 per case of acute ischemic stroke treated with a thrombolytic. The move could have major implications in the treatment of stroke patients in the U.S., said Dr. Kieran Murphy, director of interventional neuroradiology at Johns Hopkins University.
"We have been barely breaking even for some time here. Even though we have an excellent program in place that allows us to treat these patients appropriately, we've had to be very cautious, trying to lose as little money as possible. This is definitely a step forward," Murphy said.
The move will result in a better use of taxpayers' money by helping physicians treat more stroke patients, get them in rehabilitation earlier, and send them back to work or home faster, he said. It will also help stroke specialists justify their demands for adequate infrastructure, including that needed to perform acute interventions.
Treating patients with tPA is risky. Side effects as extreme as acute bleeding have been reported. But specialists agree the drug's advantages outweigh its risks.
Many resources are needed to effectively treat stroke patients. A number of organizations, including the American Stroke Association, lobbied CMS to come up with a new code that would compensate hospitals already providing treatment with tPA and would eliminate the financial considerations restraining others.
Coming on the heels of the approval of carotid artery stenting, CMS's move signals a patient advocacy role and a will to salvage people who could go back to productive, happy lives, Murphy said.
CMS published its Final Rule for the Inpatient Prospective Payment System (IPPS), including the new reimbursement category, in the Federal Register today.
The FDA approved tPA use in 1996, after data proved the drug could reduce potential brain damage from an ischemic stroke caused by blood clots. Thrombolytic therapy has been shown to be most effective when used within the first three hours after stroke onset.
The feds requested public comment on the change or creation of the reimbursement codes for stroke in 2006, based on reasonable belief that more patients were being treated with reperfusion agents than the official data indicated. Advocates supporting the creation of DRG 559 cited the benefits of thrombolytic therapy in patients with severe strokes versus the increased costs of caring for these patients.
The FDA will continue to monitor all existing DRGs, leaving an open door for further changes as improvements in treatment and technology take place.
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