Managing the aftermath of acute stroke

According to the 2002 U.S. Health Care Utilization Project's Hospital Characteristics for Acute Stroke Patients, approximately 28% of the people who suffered acute stroke were under 64 years of age. Of those 158,563 people, 34.5% either died or were confined to long-term care facilities. These are troubling numbers when one thinks of the loss to families and communities. But equally alarming are the costs associated with healthcare for these stroke patients. Young people face anywhere from 35 to 50 years of being disabled, requiring special education, vocational rehabilitation and/or special assistance to maintain their independence.

In 2003, the Saint Luke's Mid America Stroke and Brain Institute, a comprehensive stroke treatment center in Kansas City, Mo., tracked the costs of stroke treatment, concluding that acute care was less expensive when it was specialized.

To illustrate, it reported cost data for two patients' stroke treatments. A 43-year-old man suffered a stroke and received specialized stroke intervention. He was hospitalized for four days, suffered no long-term disability, and his health insurance paid the full $36,046 for his care. A 47-year-old man received no specialized stroke intervention. His hospital stay was nine days long at a cost of $57,515 with an additional $53,031in rehabilitation.

Managed care executives, medical directors and other healthcare professionals cannot ignore these numbers. And as The Stroke Network estimates that over the course of a lifetime, four out of five American families will be touched by stroke, the average citizen must take note and ask questions.

Although relationships between health insurance carriers, employers and employees are complex, innovative approaches must be developed to encourage improved healthcare awareness and practices among the general public. The extent to which a payer can educate its members requires a strong partnership with the employers that will work toward everyone's benefit.

Costs are dramatically affected by the speed at which a stroke is identified and treated. Thus it would benefit employers, insurers and hospitals to work together to provide educational programs and incentives to educate employees and healthcare professionals on symptom recognition and the importance of seeking immediate treatment.

There are multiple ways to engage employees, such as providing information about reducing disease risk factors like smoking, diabetes, high blood pressure and obesity. These methods can benefit members with improved health, and payers with reduced acute and long-term health costs.

Ischemic strokes are caused by blockages of the blood vessels in the brain and account for 80% of strokes. For hemorrhagic stroke survivors, the lifetime cost as of 2003 is projected to be $175,000. Hemorrhagic strokes result from a weakened blood vessel that ruptures and bleeds into the surrounding brain, accounting for some 20% of strokes.

The key to a full recovery starts the moment a person exhibits stroke symptoms. It requires that the victim, or the people around him or her, recognize the symptoms and immediately call for help. It also requires seeking treatment at a hospital with neuro critical care experts on hand who can read a CT scan accurately and recommend the best course of action.

Patients who receive appropriate care within the first three hours of onset dramatically increase their potential to regain normal functioning. However, according to the New England Journal of Medicine, the median time from stroke onset to arrival in an ER is between three and six hours, according to 48 studies from 17 countries documenting delay in seeking and obtaining treatment.

The economic impact of treating stroke has become significant enough that states are beginning to set new guidelines aimed at reducing time to treatment. Currently, Massachusetts, New Jersey and Florida have enacted legislation that mandates hospitals and emergency medical services teams configure emergency response systems and strategies that will improve access and reduce time to emergency neurology care. There is an opportunity for payers to benefit from a new wave of state efforts to reduce the incidence of stroke and increase preventive interventions. It is also in their best interest to allow for reimbursement of new technologies and services that can reduce long-term costs.

As legislators toil to bring about effective change in the treatment of stroke, hospitals in the U.S. and abroad must be prepared to implement effective strategies.

While hospital administrators, health insurers and those involved with industry economics realize that the healthcare system must be modified to address the growing economic impact of stroke, there is not consensus about how this should occur. One model focuses on public awareness and education, while another points to revising the reimbursement system. Another advocates timely specialized treatment through the use of telemedicine, while still another model spotlights the need to provide a continuum of care model similar to that related to chronic illness. Success in reducing the growing impact of stroke will incorporate multiple preventive and treatment interventions whose aim is to relieve pressure on our overburdened healthcare system, while maintaining high-quality patient care.

James Elkind is founder and general manager, data division, for Brain Saving Technologies.