Article Text

Download PDFPDF

E-123 From coast to coast- the uneven spread of lifesaving stroke interventions
Free
  1. S Mannam,
  2. A Napole,
  3. S Kandregula,
  4. G Sioutas,
  5. P Davis,
  6. S Ajmera,
  7. J Burkhardt,
  8. V Srinivasan
  1. Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Abstract

Introduction Mechanical thrombectomy (MT), a time-sensitive neurovascular intervention for ischemic stroke, has demonstrably improved patient outcomes. However, concerns persist regarding geographical disparities in MT utilization. This study aimed to analyze the geographical variation in MT procedures reimbursed by the Centers for Medicare & Medicaid Services (CMS) from 2016 to 2021.

Materials and Methods We conducted a retrospective analysis of publicly available Medicare data from CMS for the period January 1, 2016, to December 31, 2021. Current Procedural Terminology (CPT) code 61645 was used to identify MT procedures, and inflation adjustments were applied. Descriptive statistics were employed to analyze geographical trends in MT utilization.

Results The states performing the most mechanical thrombectomies were California, Florida, Texas, Tennessee, and New York, spanning 1,698 to 2,791 procedures. New York, California, Florida, Texas, and Pennsylvania had the highest submitted charges, ranging from $5.2 to $16.9 million. The highest reimbursements were observed in California, Florida, Texas, New York, and Illinois, between $1.2 and $2.0 million. Notably, no procedures were billed for Medicare in Wyoming, Montana, and Alaska. Additionally, six states reported fewer than 100 thrombectomies, suggesting variations in access or utilization across regions.

Conclusion This study highlights geographic disparities in MT utilization reimbursed by Medicare. The observed trend of higher MT volumes in states with larger populations suggests a potential correlation between population density and access to MT. However, the complete absence of reimbursed MT procedures in three states warrants further investigation. Potential explanations for these discrepancies include limited Medicare funding, infrastructure deficits, and socioeconomic disparities. Inadequate Medicare reimbursement rates in specific regions might disincentivize hospitals from performing MT procedures, particularly for Medicare-eligible patients. The lack of essential infrastructure, such as specialized stroke centers and neurointerventional expertise, could be hindering MT availability in certain geographical areas. Socioeconomic factors, potentially influencing access to healthcare and stroke risk, might contribute to the observed geographical variations.

Future research should explore these potential causes and incorporate data beyond Medicare claims, such as private insurance coverage and regional stroke center distribution. This comprehensive approach is critical to elucidate the full picture of geographical disparities in MT utilization. Furthermore, investigating patient-level factors, such as stroke severity and presentation time, could provide insights into potential disparities in treatment eligibility across different regions. Addressing these geographical inequities in MT access is crucial to ensure equitable distribution of this life-saving stroke treatment and improve overall patient outcomes.

Disclosures S. Mannam: None. A. Napole: None. S. Kandregula: None. G. Sioutas: None. P. Davis: None. S. Ajmera: None. J. Burkhardt: None. V. Srinivasan: None.

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.