Abstract 12: Do “Drip and Ship” Cases Incur Higher Costs to Warrant CMS MS-DRG Reassignment?
Background: Telestroke networks enable acute stroke patients to receive r-tPA at a remote hospital (ie, spoke) emergency department and are subsequently transferred to another hospital (ie, hub) for additional care - commonly referred to as “drip and ship” (D&S). While hub hospitals do not administer r-tPA in D&S cases, they handle all subsequent care for these patients upon arrival. It is hypothesized that current CMS reimbursement rates do not reflect the higher cost to hospitals that receive D&S patients.
Objective: Compare hospital costs and reimbursement rates for Medicare patients with AIS who received r-tPA, did not receive r-tPA, and were treated and sent to hub hospitals.
Methods: The study included Medicare-covered patients hospitalized with a primary diagnosis of AIS (ICD-9 codes 433.x1, 434.x1, 436) admitted between 6/9/2007 and 12/30/2012 from 5 hub hospitals in the Premier research database with telestroke implementation ranging from 10/2009 - 12/2011. Treatment arms were defined as r-tPA (billing data), D&S (ICD-9 =V45.88), or none. Costs were reported from the hospital perspective and compared with CMS reimbursements based on MS-DRG assignment. Median costs were compared using the Wilcoxon ranked sum test.
Results: 4122 patients were included in the study, with 84 (2%) receiving r-tPA treatment and 233 (6%) having D&S treatment. Total costs and reimbursement rates are summarized in Table 1.
Conclusions: Results from the study demonstrate D&S cases were associated with higher costs than untreated cases, despite not administering r-tPA; however, they were reimbursed similarly. Future reassignment of MS-DRG to these cases may be warranted.
Author Disclosures: W.K. Mountford: Employment; Significant; Premier. J. Wagner: Speakers' Bureau; Modest; Genentech. Honoraria; Modest; Genentech. Consultant/Advisory Board; Modest; Genentech. M.R. Krukas: Employment; Significant; Premier Healthcare Alliance. D. Tayama: Employment; Significant; Genentech. Other; Significant; Genentech/Roche. F.R. Ernst: Employment; Significant; Premier Healthcare Alliance. E. Chen: Employment; Significant; Genentech. Other; Significant; Genentech/Roche.
- © 2015 by American Heart Association, Inc.