| Abstrakt: |
Background.Tissue plasminogen activator (tPA) is recommended for stroke patients presenting within 3 hours of symptom onset. Patients treated with tPA have been shown to experience superior outcomes over other thrombolytics. Higher costs for tPA are said to be offset by savings from shorter lengths of stay and lower likelihoods of being discharged to rehabilitation or long-term care. Encouraged by the American Stroke Association (ASA), CMS created DRG 559 in FY 2006, increasing the reimbursement for stroke patients receiving tPA by an average of 6,700 to advance tPA utilization. In FY 2007, CMS replaced DRGs with severity-adjusted DRGs (MS-DRGs); three MS-DRGs replaced DRG 559, lowering the reimbursement rate for tPA treatment. The primary data source was the HCUP 2005-2007, Nationwide Inpatient Sample, a 20 sample of up to 700 hospitals per year in 27 states. Discharge records were analyzed for patients aged 45 and older, with a discharge diagnosis for cerebral infarction (ICD-9 codes 362.3, 433.x1, 434.x1, and acute, but ill-defined, cerebrovascular disease (ICD-9 code 436) and excluding secondary diagnoses of traumatic brain injury (codes 800-804, 850-854). Patients were stratified by age, payer, and DRGs 61, 62, 63 or 559 with a primary ICD-9 procedure code of 99.10. |
