Despite the fact that thrombectomy is extremely effective in saving the lives of stroke patients, Medicare has been paying lower rates for the procedure over time, based on research presented today on the Society of NeuroInterventional Surgery (SNIS) 21 conference.saint Annual meeting.
Three studies, “The Price of Progress—Assessing Medicare Pricing for Stroke Treatment,” “The Financial Clogs of Stroke Treatment: A Dilemma for Reimbursing Mechanical Thrombectomy,” and “From Coast to Coast—The Uneven Distribution of Life-Saving Interventions for Stroke,” point to deteriorating Medicare reimbursement rates and their potential impact on thrombectomy availability.
The primary two studies analyzed publicly available data on 34,696 thrombectomy procedures performed between 2016 – when the procedure was widely proven to be secure and effective – and 2021.
“The Price of Progress—An Assessment of Medicare’s Pricing for Stroke Treatment” reveals that although thrombectomy has saved the USA tons of of hundreds of thousands of dollars in health and social service costs for individuals who have had an acute ischemic stroke, Medicare doesn’t even come near covering the estimated $13,000 cost of every procedure. The common Medicare bill for thrombectomy through the study period ranged from $3,083.11 to $3,783.53, but the typical Medicare reimbursements ranged from $620.80 to $686.81—only 18.15% to 21.845% of what was billed.
“Fiscal Clots within the Stroke Care Stream: The Reimbursement Dilemma for Mechanical Thrombectomy” shows that these reimbursement declines occurred despite a virtually threefold increase within the variety of thrombectomy procedures through the study period, from 2,466 in 2016 to 7,210 in 2021. Furthermore, while Medicare reimbursement for thrombectomy has declined, overall Medicare spending has increased—from $670 billion in 2016 to $829 billion in 2021.
The article, “From Coast to Coast—Uneven Distribution of Lifesaving Interventions for Stroke,” suggests that inadequate Medicare reimbursement rates in some regions may discourage hospitals from offering thrombectomy services, especially for Medicare-eligible patients.
“Thrombectomy shouldn’t be just the gold standard for treating acute ischemic stroke—it’s a lifesaver that quickly restores blood flow to the brain, dramatically improving patient outcomes. Yet, alarmingly, as efficacy has improved, Medicare reimbursement has declined rapidly,” said Sneha Sai Mannam, lead creator of the study and a medical student on the University of Pennsylvania who conducted the research within the NeuroVERT lab under the direction of Dr. Visish Srinivasan. “It’s critical that Medicare policy evolves to accurately price this essential procedure and ensure universal access, no matter a patient’s financial situation. We cannot allow financial considerations to interfere with optimal patient care.”
To receive a replica of this abstract or to talk to the study creator, please contact Camille Jewell at [email protected] or call 202-248-5460.