Medicare shortchanges hospitals on stroke therapy

Interesting look on an issue that will eventually have to be reconciled. Reuters reported that Medicare shortchanges hospitals on stroke therapy:

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.

... 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.

A state that needs help...

Being born in Arkansas, I am always drawn to news in that state. A recent story combines my home state with some serious news: saving stroke patients in a state with a high stroke death rate.

Doctor says telemedicine helps save stroke patients:

Arkansas is ranked No. 1 for stroke deaths in the country.

"A physicians shortage is a big part of it," said Northwest Medical Center Emergency Medical Director Dr. Katherine Barton. "Unfortunately, some parts of our state are very poor. There's just not always enough access to physicians like people need. There's not education about strokes that we need to have out there. And there's a lot of cardiovascular disease in our state because of a lot of obesity and smoking."

When it comes to strokes, time is everything.

"The more time that passes, the more damage that's done, the more brain cells that die and the more of your function you cannot get back," said Barton.

(Map from the U.S. Centers for Disease Control and Prevention)

Speed and skill - a stroke-fighting combination

A great story - and a reminder that quick response can make a huge difference for stroke patients - comes form Oregon, where a man's quick-acting wife and skilled doctors affected his recovery. Here's a snipped, but you should read the whole thing:

Around 7:15 a.m., 75 minutes after the first stroke symptoms, tPA began dripping into a vein in Steve's right arm. Within 15 minutes, his "word salad" disappeared. He could speak clearly.

As the intravenous drip continued, an ambulance drove Steve to Providence St. Vincent, so neurologists could observe him, and try to determine what caused the stroke.

About 48 hours later, on Thursday, Steve still wore blue pajama pants and a less-than-cozy hospital gown. But his shoes stood nearby as he waited to be discharged. Even doctors were stunned by his swift recovery, his speech and memory restored.

Finding the 'hidden' disabilities

Not all post-stroke disabilities are easy to detect - sometimes adding to recovery difficulties. One recent article discussed how better detection of the "hidden" disabilities can help stroke survivors get help they need:

Health workers detecting the condition after a stroke could make cognitive intervention to improve the patient’s function and prevent chronic disability, according to Anna Barrett, M.D.. She is the director of Stroke Rehabilitation at the [Kessler] Foundation.

"Early detection of spatial neglect after stroke could enable cognitive interventions to improve function, and might prevent chronic disability."

Study confirms common sense link

It makes sense that obesity can be a factor in stroke risk. So it also makes sense that fighting obesity would mean fighting stroke risk.

That common sense is somewhat confirmed as a study showed weight-loss surgery can cut deaths from strokes:

The study appears in the latest issue of  the Journal of the American Medical Association.

The researchers checked the health and body weight of the participants at 2, 10, 15 and 20 years. ...

During the follow up, which lasted an average of 14.7 years, the researchers found patients who didn't have surgery suffered more heart disease and more fatal heart attacks and strokes.

Stroke prevention tips

Not all strokes can be prevented - but most are  preventable.

Recently found this link to top 10 stroke prevention tips:

Did you know that 80% of all strokes can be prevented? Strokes have the reputation of randomly striking out of nowhere. But you have more control to prevent strokes from happening than you might think. Here are our top ten prevention tips.

Regular readers of this blog will know some if not all of these, but this list is a good set of reminders.

Compilation of aphasia info...

My Google alerts sent me a link about a topic that is close to me: aphasia.

I struggled with language - even still, to a degree - after my 1998 stroke. A link listing 10 things to know about aphasia:

If a stroke has left you with lingering language problems, called aphasia, you might recover some limited abilities on your own. However, you'll probably need speech-language therapy for the best possible improvement. Fortunately, experts know more today than ever before about treating aphasia effectively. Here are 10 essential facts about the most up-to-date treatment strategies.

I watched, once again, Dick Clark struggle with aphasia as 2012 began over last weekend. More power to him!