The ROI of mobile stroke units

In stroke care, swift treatment is key to preventing death and disability, and health systems looking to get ahead on incentives for population health might consider new investing .

The Cleveland Clinic and the University of Texas Health Science Center at Houston are using the nation’s first mobile stroke units to treat stroke patients sooner, and both show promise in preserving patients’ quality of life and saving a great deal of money for the U.S. healthcare system.

Currently, when someone experiencing stroke symptoms makes a 911 call, they are not fully evaluated until they enter the hospital, and if they’re suffering an ischemic stroke, it takes on average 62 minutes for them to receive the clot-busting, brain-saving tPA (tissue plasminogen activator) therapy, said Stephanie Parker, RN, project manager of UTHealth’s Mobile Stroke Unit in Houston.

In other words, that’s a loss of around one hundred and twenty million neurons, since two million die every minute during a stroke.

In contrast, mobile stroke units can be dispatched to the scene and literally bring the ER to the patient’s driveway. Inside a unit, a portable CT scanner images the patient’s brain, providing immediate results for determination of whether the patient should be treated with tPA.

“We can bring a highly trained team of individuals with no other distractions directly to the scene,” said Peter Rasmussen, MD, director of Cleveland Clinic’s Cerebrovascular Center. And via telemedicine, "[the stroke unit] can bring a world caliber expert, a clinical neurologist, to the home, versus a patient going to the local hospital,” he added.

“The mobile stroke unit provides faster time-to-treatment and also reduces costs,” Rasmussen said. “Most of the cost is in the cost of caring, in rehabilitation. The best way to reduce the cost is to introduce treatment as quickly as possible.”

According to Rasmussen and Parker, mobile stroke units may be able to reduce the need and costs for acute care and improve outcomes to the extent that rehabilitation services become unnecessary or are significantly lessened.

If the Cleveland Clinic and UTHealth show that’s possible, mobile stroke units have the potential to save billions of dollars if they are incorporated into ambulance fleets throughout the country. And Rasmussen indicated that there is interest from many academic and non-academic healthcare centers throughout the United States.

Currently, the mobile stroke unit is undergoing a two-year study at UTHealth, the home of the nation’s first unit. The study aims to ascertain if administering tPA faster improves patient outcomes, and then measure cost effectiveness, Parker said.

“We're at $200,000 just for acute care for every stroke patient,” Parker said. The mobile stroke unit “costs $500,000, the CT scanner itself costs $360,000, and it can be easily implemented into any fleet. That means it will basically pay for itself by reversing two to three strokes."

To date, Medicare is not paying any extra for the units, but in 2017, Medicare's inpatient quality reporting program will require a set of metrics on stroke care, including the time it takes for patients to get tPA therapy. And with 34 percent of hospitalized stroke victims being younger than 65, private insurers may also have an interest in seeing mobile units spread.

“I think it would be wonderful if Medicare would incentivize for these units because in theory patients would be doing better,” Rasmussen said.

Parker is of a similar opinion. “I definitely think it should be looked at, and I personally feel that early administration does make a difference,” she remarked. “Our first patient [on the stroke unit] was a thirty year old female with basilar artery thrombosis and we treated her within 60 minutes. Whereas it would have taken about an hour and a half if she had not been treated on the scene. She's now living independently and she didn't have to go to rehab.”