Abstract P31: Medicare Reimbursement and Patterns of tPA Utilization for Acute Ischemic Stroke Patients

Autor: Meg M. Comins, Deanna Wathington, Dawood H. Sultan
Rok vydání: 2011
Předmět:
Zdroj: Circulation: Cardiovascular Quality and Outcomes. 4
ISSN: 1941-7705
1941-7713
DOI: 10.1161/circoutcomes.4.suppl_1.ap31
Popis: 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. Results. From 2005 to 2006, tPA utilization increased 68.1%, but increased only 1.36% from 2006 to 2007. tPa uitilization increased for Medicare and Medicaid patients overall, but declined for privately insured patients from 2006 to 2007. Discussion. The Brain Attack Coalition endorses statewide stroke systems of care, including certification of comprehensive and primary stroke centers. Comprehensive centers must be capable of providing the full range of stroke care including tPA to patients. Seven states were developing, or had in place stroke systems of care in 2007. The decline in reimbursement may act as a disincentive to other states to create systems of care. Stroke patients with tPA as the primary procedure, number and percentage of tPa patients by row. 2005 (n=60,009) 2006 (n=57,298) 2007 (n=55,669) tPA Patients 789 (1.31) 1326 (2.32) 1344 (2.41) DRG 14 480 (60.84) - - DRG 559 306 (38.78) 1,317 (99.3) 977 (72.7) DRG 61 - - 96 (7.1) DRG 62 - - 170 (12.6) DRG 63 92 (6.8) Medicare 506 (1.15) 883 (2.16) 899 (2.3) Medicaid 32 (1.09) 58 (1.86) 67 (2.08) Private Insurance 213 (2.13) 309 (3.26) 296 (3.05)
Databáze: OpenAIRE
Externí odkaz: