Baltimore, MD - The US Centers for Medicare and Medicaid Services (CMS) will be doubling hospital reimbursement rates for ischemic stroke in Medicare patients who receive tissue plasminogen activator (tPA, Genentech Inc), a CMS spokesperson confirmed to heartwire today. The new diagnosis-related group (DRG)—DRG 559, "Acute ischemic stroke with use of thrombolytic agent"—will take effect October 1, 2005 and will be announced when changes to the Federal Register are made public later this month.

Ischemic stroke has hitherto been reimbursed under DRGs 014 and 015 at a flat rate of $5700 US. Under the new DRG, hospitals will be reimbursed an additional $6000 or more per patient, an amount that takes into consideration not merely the cost of tPA but also the additional tests and costs.

Dr Dawn Kleindorfer (University of Cincinnati, OH) commented on the CMS decision to heartwire, emphasizing that tPA is only one of the added costs in this patient group. "The idea was to help defray the costs in these patients, and it's not just the cost of the tPA—the drug itself costs $2000 per dose—but also that these people are sicker and need more time in the ICU and are a lot more expensive to take care of," she observed. "You end up using up your entire reimbursement for the DRG within a couple of days, so hospitals currently are taking a hit, and this will help them be able to take care of stroke patients without losing money."

"This is the first time that the CMS has recognized, through the creation of a new DRG, the importance of treating acute ischemic stroke with a thrombolytic agent," Genentech spokesperson Marites Cristobal told heartwire.

The new DRG was created to address concerns that useful treatments such as tPA were being underutilized in acute ischemic-stroke patients, a CMS spokesperson told to heartwire. Cristobal, however, said that Genentech was not expecting to see a major change in tPA patterns of use: "We anticipate that the impact of this new DRG will be minimal; however, it is too early to determine the effects on sales and usage in this setting."

Kleindorfer agreed that only time will tell. "I'm hoping it will increase the use of tPA, that's the idea, but I don't know if it's going to happen until the new DRG actually goes into effect."

She added that tPA is the only thrombolytic approved for acute ischemic-stroke patients but that the new DRG is not restricted to tPA use. "The ruling by the CMS did leave open the possibility that if there are other proven therapies that come forward in the future, they could be considered for adding to the DRG, but right now [the CMS] can go by only what's FDA approved."