Published Online
on February 3, 2005

A more recent version of this article appeared on March 1, 2005

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Submitted on September 2, 2004
Revised on November 22, 2004
Accepted on November 25, 2004

A Description of Canadian and United States Physician Reimbursement for Thrombolytic Therapy Administration in Acute Ischemic Stroke

Dawn Kleindorfer MD^*; Michael D. Hill MD, FRCPC; Daniel Woo MD; Thomas Tomsick MD; Arthur Pancioli MD; Brett Kissela MD; Andrew M. Demchuk MD; David Losiewicz BS; Edward Jauch MD, MS; Alexander Schneider MD; Andrew Ringer MD; Daniel Kanter MD; and Joseph P. Broderick MD

From the Departments of Neurology (D.Kleindorfer, D.W., B.K., A.S., D. Kantner, J.P.B.), Radiology (T.T.), Emergency Medicine (A.P., E.J.), and Neurosurgery (A.R.), University of Cincinnati College of Medicine, Cincinnati, Ohio; the Department of Clinical Neuroscience (M.D.H., A.M.D.), University of Calgary, Calgary, AB, Canada; and University Neurology Inc (D.L.), Cincinnati, Ohio.

^* To whom correspondence should be addressed. E-mail: dawn.kleindorfer{at}uc.edu.

Background and Purpose--Acute ischemic stroke patients are infrequently treated with rtPA, despite its proven effectiveness. Poor physician reimbursement for acute stroke care is one possible explanation for the low frequency of use. We describe the physician reimbursement for thrombolytic therapy for the stroke team physicians serving the Greater Cincinnati/Northern Kentucky region (GCNK), and the Alberta region.

Methods--GCNK: billing logs were accessed for the study period of 7/01-12/02, and cross-matched to stroke call logs. University of Calgary (UC): treatment records of a single physician were reviewed from 4/02-3/04. A telephone survey of Canadian provinces was conducted regarding billing practices.

Results--GCNK: During the study period, 151 patients received rtPA. For treated pts. the average time spent was 2.6 hours, and average reimbursement received was $472 (of those with insurance). The highest reimbursement was received by billing critical care codes. Reimbursement for critical care was similar to or lower than common office procedures for neurologists. UC: during the study period, 131 patients received rtPA. Average reimbursement for rtPA treated patients was $340 US, not including on-call payments. Survey across Canada revealed many provinces with weekend/after hour premium stipends and on-call stipends.

Conclusions--Physician reimbursement for the evaluation and treatment of acute stroke, when compared with other diagnoses commonly treated by neurologists, is relatively low in both the U.S. and Canada. Health policy decision-makers in the US and Canada should be made aware of the importance of providing a more balanced plan to provide medical care to stroke patients.

Key words: stroke, acute • stroke, ischemic • tissue plasminogen activator • thrombolytic therapy

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