Background:
Mobile Stroke Units (MSU) provide hyperacute diagnosis and treatment in the prehospital setting and are growing in number around the world. However, USA MSU reimbursement limits program proliferation and increases dependency on grants to support program costs. Therefore, we aimed to understand the USA MSU reimbursement paradigm.
Methods:
IRB approval was obtained for the conduct of an anonymous national MSU survey. Survey items were developed by MSU leaders experienced with reimbursement models and disseminated to all USA MSU programs. Returned data were entered and analyzed in SPSS using descriptive statistics.
Results:
Of the 20 existing USA MSU programs, 19 (95%) returned surveys. Programs work 26
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6 (median 30) days per month serving a median 240 sq. mile radius with a median 600 dispatches per year; 47% describe their service area as metropolitan, 16% as rural, with 37% serving both. A median 4 people staff the MSU with 37% including an MD and 16% including an APP as the expert on board; the remaining programs use telemedicine MD coverage. Two programs are classified as “virtual ED” with 1 of these not classified as an EMS vehicle; 1 MSU is classified as an “outpatient clinic” with all other programs classified as EMS vehicles; 21% are certified CT Mobile Laboratories. During the last 12 months, overall the 19 responding programs gave on average 72
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78 (median 30) alteplase tPA treatments. Of the 15 programs providing billing practices, 47% bill EMS ALS charges; supplemental billing included CT (53%), critical care (5%), telemedicine (53%), tPA (21%), and labs (5%), however, collection was poor. Overall, programs described their financial performance as negative, with only 1 program (outpatient clinic) defining it as positive; 100% rely in part or totally on grants, philanthropy, or institutional support to sustain the program.
Conclusion:
USA billing restrictions challenge MSU financial sustainability limiting reimbursement to traditional EMS ambulance services. Given the importance of early MSU treatment to reduce disability and death, new financial models are needed to ensure the viability of MSU services.
The PRE-hospital Stroke Treatment Organization
