Abstract 209: Analysis of the Costs and Payments of a Coordinated Stroke Center and Regional Stroke Network

Objective: A comprehensive regional stroke program implemented at Saint Luke’s Neuroscience Institute (SLNI) was recently shown to generate increased access to advanced stroke care and improved patient management and treatment per guidelines. The purpose of this current study was to evaluate the costs associated with implementing a progressive, comprehensive stroke program at SLNI. Methods: This was a retrospective analysis of total hospital costs and payments received from all payers for treating ischemic stroke patients at SLNI as program enhancement evolved over time (2005, 2007, 2010). Results from SLNI were compared with previously published national benchmarks. The analyses were stratified by patient demographic characteristics, patient outcomes, treatments, time, and comorbidities. Results: Financial and clinical registry data were available for 1,570 SLNI patients with an acute ischemic stroke. The median total cost (direct + indirect costs) per patient was $12,812. Controlling for inflation, there was no difference in SLNI total costs between 2005 and either 2007 or 2010. However, after controlling for inflation, SLNI median costs were lower in some subgroups compared to national estimates including discharged to home/home health care ($14,247 versus $16,613), females ($15,907 versus $19,826), and patients with an intracranial hemorrhage ($20,339 versus $26,470). Within SLNI patients, those discharged to home or home healthcare were -$1,712 less costly than patients discharged to other locations. In addition, patients who were 65 years of age and older were less costly (-$1,852) than younger patients. Patients receiving intra-arterial tPA or an embolectomy were associated with a $7,568 higher cost than patients who did not receive these treatments. Longer stays were associated with an increased cost of $2,246 per day. The median financial data indicated that the SLNI profit margin was negative for managing patients diagnosed with acute ischemic stroke across the study population. Multivariate analysis revealed lower payments of -$5,575 were associated with each patient age 65 years or older, while longer lengths of stay increased payment by $1,283 per day. Conclusions: This analysis indicates that SLNI has successfully implemented a comprehensive program with coordinated regional care, dedicated high-level staffing, state-of-the-art technology, and process efficiencies that results in better access and care while overall total hospital costs remained unchanged. However, SLNI total operating costs continue to outweigh payments, similar to that observed in previous studies, indicating the need for further reimbursement consideration. Despite such reimbursement challenges, this study suggests a comprehensive stroke care program with improved access and treatment may be financially feasible for other hospitals to implement.