Lack of reimbursement limits availability of mobile stroke units

por John R. Fischer, Senior Reporter | March 15, 2021
Cardiology Mobile Imaging Stroke
Mobile stroke units are not widely available due to limited reimbursements (Photo courtesy of Lehigh Valley Health Network Mobile Stroke Unit)
Limited reimbursement makes operating mobile stroke units financially challenging and has made them widely unavailable.

That’s according to preliminary research to be presented this month at the American Stroke Association’s International Stroke Conference 2021. The main issue, says lead author Kenneth Reichenbach, is that there is no established means for the government or private insurers to reimburse the cost of mobile stroke unit care, especially for CT scans and medication administered outside hospital.

“We need overwhelming, united support for this to change within federal entities, including the Centers for Medicare and Medicaid Services, to explore appropriate pathways for Medicare reimbursement for the full range of advanced mobile stroke unit services,” Reichenbach, program director of the Mobile Stroke Unit at Lehigh Valley Health Network in Pennsylvania, said in a statement.
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All 20 U.S. mobile stroke programs are partially funded through personal gifts, grants or institutional support. A blind survey by Reichenbach and his colleagues from June 2019 found that out of 19 mobile units, 18 had a negative financial status based on the last 12 months of their operation. The sole one with a positive status classified itself as an outpatient clinic rather than an ambulance. The 20th did not respond.

The programs together administered clot-busting medications to stroke patients 72 times a year on average, and each was open nearly every day of the month. This led to 600 responses per year, on average, among all of them. All are equipped to perform CT scans and had an average of four staff members: a CT technologist, paramedic/emergency medical technician, stroke nurse, and either a doctor or advanced practice healthcare professional as a stroke expert. For 47% of programs, telemedicine connected patients remotely to a stroke expert.

The need for support is backed by the American Heart Association’s 2019 Recommendations for the Establishment of Stroke Systems of Care, which suggests that reimbursement for mobile stroke units is an issue that warrants further investigation. A recent study in Germany also found that mobile stroke units offer patients a greater chance of survival and avoidance of long-term disability.

Part of what makes private funding necessary for mobile units now is billing restrictions from healthcare providers, according to Reichenbach. “If mobile stroke units cannot be reimbursed for the important care they provide, this vital service will be lost, unless private donors are willing to continually step up to support these programs.”

The study was funded by the Prehospital Stroke Treatment Organization.

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