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.

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.

Medicare is the government health insurance program for the elderly and disabled, with most recipients being age 65 and up. It is coming under increasing scrutiny as the government seeks ways to cut spending - healthcare being one of the biggest federal costs.

The non-partisan Government Accountability Office has said that, left unreformed, Medicare - along with Social Security and Medicaid - will eat up 100 percent of all tax revenues by 2047.

“It’s a difficult problem,” Cloft said. “Medicare is trying to hold down costs.”

And it’s possible that the hospitals can find ways to curb their costs, rather than asking more of Medicare.

The current study, which used a government database on U.S. hospital discharges, looked at overall costs to hospitals for treating tPA patients. It did not look at specific, “line-item” costs to see if there are areas where hospitals might save money, Cloft said.

That’s what he and his colleagues will study next, he added.

Cloft’s team did find that hospitals’ costs varied significantly based on their location. In the South, the typical cost of hospitalizing a tPA patient was just over $14,500; in the Northeast and West, that figure hovered around $19,000.

There was a similar gap between rural and urban hospitals - where the typical costs were $14,000 and $18,500, respectively.

SOURCE: Stroke, online December 22, 2011

###

  Waleed Brinjikji, MD;
  Alejandro A. Rabinstein, MD;
  Harry J. Cloft, MD, PhD