Despite mechanical thrombectomy’s high success rate in saving the lives of stroke patients, Medicare is paying lower rates over time for the procedure in the USA. That is according to three separate studies presented earlier this week at the Society of NeuroInterventional Surgery (SNIS) annual meeting (22–26 July, Colorado Springs, USA).
These studies highlight worsening US Medicare reimbursement rates and their potential impact on the availability of thrombectomy, as stated in an SNIS press release. The release also notes that findings suggest the federal health insurer “continues to undervalue” this procedure.
The first two studies analysed publicly available data from 34,696 thrombectomy procedures performed between 2016, when the procedure was widely proven safe and effective, and 2021.
“The price of progress: evaluating Medicare’s valuation of stroke treatment”, the first of these studies, has revealed that—although thrombectomy has saved the USA hundreds of millions of dollars in health and social care costs for people who have experienced acute ischaemic stroke—Medicare does not pay nearly the total cost of each procedure, which is estimated at US$13,000. The average charge for thrombectomy submitted to Medicare during the studied time ranged from US$3,083.11 to US$3,783.53, but Medicare’s reimbursements averaged from US$620.80 to US$686.81—roughly 18–22% of what was submitted.
The second study, titled “Fiscal clots in the stream of stroke care: the mechanical thrombectomy reimbursement dilemma”, has demonstrated that these reimbursement decreases happened despite thrombectomy procedures nearly tripling during the studied timeframe, from 2,466 in 2016 to 7,210 in 2021. Furthermore, the study found that, while Medicare’s reimbursement for thrombectomy was decreasing, overall Medicare expenditures were increasing—from US$670 billion in 2016 to US$829 billion in 2021.
“From coast to coast: the uneven spread of lifesaving stroke interventions”, the third and final of these studies, has produced findings suggesting that inadequate Medicare reimbursement rates in specific regions may disincentivise hospitals from offering thrombectomy services, particularly for Medicare-eligible patients.
“Thrombectomy isn’t just the gold standard for treating acute ischaemic stroke—it’s a lifeline that swiftly restores blood flow to the brain, dramatically improving patient outcomes. Yet, alarmingly, as its efficacy soars, Medicare reimbursement plummets,” said Sneha Sai Mannam (University of Pennsylvania, Philadelphia, USA), the primary author of these studies and a medical student who conducted the research in the NeuroVERT lab under the guidance of Visish Srinivasan (University of Pennsylvania, Philadelphia, USA). “It is crucial that Medicare’s policies evolve to accurately value this essential procedure and ensure universal access, regardless of a patient’s financial situation. We cannot allow financial considerations to compromise optimal patient care.”
