Lack of reimbursement is not what ails tPA

CMS just announced it will explicitly reimburse hospitals when they use tPA to treat stroke patients. The drug costs about $2000 and payments to hospitals will rise by about $6000. Reimbursement usually drives utilization so why does tPA’s maker, Genentech expect the impact of the change to be “minimal”?

One explanation is that hospitals have been using tPA any way even though it’s costly. But the main reason is that tPA can only be used during the first few hours of a stroke. By the time a patient or his family calls an ambulance, gets to a hospital, gets through triage, has diagnostic tests and has them interpreted, it’s usually too late. Some of the delay is unavoidable, but many patients miss the opportunity for tPA and die or suffer irreparable harm because the health care system is too cumbersome, slow and uncoordinated.

Here’s a suggestion: Why not raise reimbursement for tPA use to $50,000 to spur wholesale re-engineering of urgent care delivery? Doing so would benefit stroke victims and help all urgent care patients as a byproduct.

See Medicare to Directly Cover Use of a Genentech Stroke Drug in the Wall Street Journal.

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August 4, 2005

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