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O-051 Fiscal clots in the stream of stroke care: the mechanical thrombectomy reimbursement dilemma
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  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. Neurosurgery, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA

Abstract

Introduction The evolution of mechanical thrombectomy has marked a significant milestone in the management and treatment paradigms of acute ischemic stroke, offering substantial benefits in patient outcomes. However, the pattern of Medicare’s reimbursement for this intervention remains inadequately explored. Notably, with Medicare expenditures increasing from $670 billion in 2016 to $829 billion in 2021, the allocation and evolution of funds specific to mechanical thrombectomy within the backdrop of improved patient outcomes merit investigation.

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 computed the mean Medicare reimbursement per procedure (total payment/total procedures). We further stratified the results by provider specialty (neurosurgery, neurology, radiology) to identify any inter-specialty disparities. Inflation adjustments were applied to all monetary values to ensure accuracy and consistency.

Results The analysis of Medicare reimbursement for mechanical thrombectomy encompassed 3 specialties and 34,696 total services from 2016 to 2021. Notably, mean reimbursement initially surged from 2016 to 2019, which was subsequently followed by a significant reduction from 2019 through 2021. This shift occurred despite the procedure’s volume nearly tripling, from

2,466 in 2016 to 7,210 in 2021. The decline in reimbursement rates was consistent across all specialties, with 2021 figures falling below the starting rates in 2016. This pattern highlights a discordance between the growing frequency of mechanical thrombectomy procedures and the downward trend in associated Medicare reimbursement over the six-year period.

Conclusion Despite the established efficacy of mechanical thrombectomy in enhancing stroke patient outcomes, a paradoxical trend of decreasing Medicare reimbursement rates has emerged. This downturn is alarming, especially considering the increased adoption and expanded indications for mechanical thrombectomy after the introduction of its CPT code in 2016. The divergence between rising Medicare expenditures and the failure to adequately reward value-based care prompts essential questions about the allocation priorities within Medicare’s budget. It signifies the necessity for a thorough review and a possible realignment of incentives to more accurately compensate for outcomes that exhibit marked clinical success. This research casts light on the urgent need for policy reforms that ensure treatments for stroke that are advancing clinical practice receive commensurate financial support in our healthcare reimbursement systems.

Abstract O-051 Figure 1

Total mechonical thrombectomies performed

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.

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