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Abstract
Introduction The introduction of mechanical thrombectomy has dramatically altered the course of acute ischemic stroke treatment, offering vastly improved outcomes for patients. However, how Medicare compensates this procedure has not been extensively examined. Questions about the sustainability of the current reimbursement model and the fairness of provider compensation need to be addressed. Literature indicates that the average cost of a mechanical thrombectomy is approximately $13,000—yet how these figures align with Medicare’s funding policies is not well-documented. This study delves into Medicare data from 2016 to 2021 to gain insight into the economics of mechanical thrombectomy reimbursement and to assess its impact on the healthcare system.
Materials and Methods This study analyzed publicly available Centers for Medicare & Medicaid Services (CMS) Medicare Physician & Other Practitioners Data (2016–2021) to encompass the mechanical thrombectomy era. We isolated mechanical thrombectomy procedures using CPT code 61645 and calculated the average Medicare charge and reimbursement per procedure across neurosurgery, neurology, and radiology, adjusting for inflation to maintain consistency.
Results Our study examined 34,696 mechanical thrombectomy procedures across three medical specialties. Total submitted charges to Medicare amounted to $120,559,741 against reimbursements of $24,677,830. In the period from 2016 to 2021, we observed an increase in both procedure uptake and charges, reflecting a growing utilization of this treatment for stroke.
The average charge submitted per procedure rose from $3,083.11 to $3,783.53, while Medicare’s average reimbursement increased from $620.80 to $686.81, indicating a persistent gap between provider charges and Medicare payments. Furthermore, there was a wide variance in provider charges, ranging from $767.24 to $36,521.74, underscoring the necessity to investigate the underlying factors of this discrepancy.
Conclusion Mechanical thrombectomy has been proven to be more cost-effective compared to standard medical management, offering significant hospital resource savings, and enhancing patient outcomes. Despite its higher upfront costs, this intervention leads to substantial downstream savings for hospital systems, estimated at hundreds of millions in health and social care costs. However, the current reimbursement model, with Medicare paying only 18.15% to 21.845% of submitted charges, significantly undervalues the procedure’s financial and clinical benefits. This discrepancy highlights the urgent need for policy reforms to align healthcare reimbursement systems with the value provided by advanced treatments like mechanical thrombectomy. Such reforms are essential for ensuring sustainable healthcare funding and fair compensation for providers, ultimately benefiting patients and the broader healthcare ecosystem.
Total charges and payments for mechanical thrombectomy
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.