Stroke is one of the new measures that hospitals must report on starting Jan. 1, 2013, to receive full Medicare reimbursement for stroke care delivered in 2015. The requirement is part of the Centers for Medicare and Medicaid Services’ (CMS) Hospital Inpatient Quality Reporting Program, which was established in 2003, with the goal of improving inpatient care.
The latest additions include 17 areas and have a total of 76 new measures. The eight measures added under stroke include venous thromboembolism prophylaxis; discharge on antithrombotic therapy; anticoagulation therapy for atrial fibrillation/flutter; thrombolytic therapy; antithrombotic therapy by end of hospital day 2; discharge on statin medication; stroke education; and assessment for rehabilitation.
Providing stroke metrics to CMS will be less challenging for primary stroke centers – those that are state or nationally certified and already collecting data on those measures, said Tim Shephard, Ph.D., vice president of Bon Secours Neuroscience Institute, Richmond, Va.
The process, however, can be challenging and costly for other hospitals, which have to figure out how to collect and report the data, he said.
Dr. Shephard, who has helped establish dozens of primary stroke centers, had the following advice:
• Be very intentional about the process: Hospitals should realize that by capturing, analyzing, and acting on these data you can reduce readmissions, complications, length of stay, and cost while improving patient outcomes. The goal should be more than just collecting and reporting the data. You should understand why the metric is important and implement robust performance improvement actions to increase adherence rates.
• Review your stroke documentation: Decide how and where you’re going to document each measure and standardize the process in multisite systems. This applies to paper, hybrid, and fully implemented electronic medical record systems. This will save time and resources when abstracting the data from the record.
• Consult early with an expert in stroke and/or neuroscience: There is a shortage of physicians, nurses, and administrative with neuroscience expertise. If this is a new process or you’re a small hospital and don’t have in-house neuroscience resources, tap into your nearest primary stroke center, the National Stroke Association’s Stroke Center Network, or the American Heart/Stroke Association for help understating the measures and implementing performance improvement action plans.
He also stressed the importance of being deliberate about the process. "Look at your stroke volume, readmission, and complication rates, and at tPA /reperfusion utilization rates. Establish your baseline performance, define your PI action plans, targets, and timeline, and ask your financial department to define your return on investment for successful implementation of this process."
Dr. Shephard added that nonstroke centers should expect some upfront costs. "If you don’t have the process in place for stroke metrics, then your cost will be higher since there will be a cost for abstracting every ischemic stroke record and collating the data.
"It can take 15-45 minutes to abstract these data from a single patient chart. It’s not going to be cost-free, but a hospital that’s deliberate about the process realizes the benefit to patients and the cost-savings downstream," he said.