Studies Suggest Medicare Undervalues Thrombectomy for Stroke

August 15, 2024—The Society of NeuroInterventional Surgery (SNIS) recently announced three new studies that demonstrate Centers for Medicare and Medicaid Services (CMS) pays lower rates over time for thrombectomy.

Lower reimbursement has occurred despite the procedure’s high success rate in saving the lives of stroke patients, stated SNIS. The three studies, which highlight worsening Medicare reimbursement rates and their potential impact on the availability of thrombectomy, were presented at the SNIS 21st annual meeting held July 22-26, 2024, in Colorado Springs, Colorado.

The studies are “The Price of Progress—Evaluating Medicare’s Valuation of Stroke Treatment,” “Fiscal Clots in the Stream of Stroke Care: The Mechanical Thrombectomy Reimbursement Dilemma,” and “From Coast to Coast—the Uneven Spread of Lifesaving Stroke Interventions”

According to SNIS, the primary author of the three studies is Sneha Sai Mannam, a medical student at the University of Pennsylvania in Philadelphia, Pennsylvania, who conducted the research in the NeuroVERT lab under the guidance of Visish Srinivasan, MD, Assistant Professor of Neurosurgery at the Hospital of the University of Pennsylvania.

As noted in the SNIS press release, the first two studies analyzed publicly available data from 34,696 thrombectomy procedures performed between 2016—when the procedure was widely proven safe and effective—and 2021.

In the press release, SNIS summarized the three studies as follows:

• The first study (“The Price of Progress...”) showed that, although thrombectomy has saved the United States hundreds of millions of dollars in health and social care costs for people who have experienced acute ischemic stroke, Medicare does not pay the total cost of each procedure, which is estimated at $13,000. The average charge for thrombectomy submitted to Medicare during the studied time period ranged from $3,083.11 to $3,783.53, while Medicare’s reimbursements averaged from $620.80 to $686.81—18.15% to 21.845% of what was submitted.
• The second study (“Fiscal Clots…”) demonstrated that these reimbursement decreases happened despite thrombectomy procedures approximately tripling during the studied timeframe: from 2,466 in 2016 to 7,210 in 2021. Additionally, Medicare’s reimbursement for thrombectomy decreased while overall Medicare expenditures increased: from $670 billion in 2016 to $829 billion in 2021.
• The third study (“From Coast to Coast…”) suggested that inadequate Medicare reimbursement rates in specific regions may disincentivize hospitals from offering thrombectomy services, particularly for Medicare-eligible patients.

“Thrombectomy isn’t just the gold standard for treating acute ischemic stroke—it’s a lifeline that swiftly restores blood flow to the brain, dramatically improving patient outcomes,” commented Mannam in the SNIS press release. “Yet alarmingly, as its efficacy soars, Medicare reimbursement plummets. 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.”