New rule from CMS for improving stroke patient care in hospitals

A new rule from the U.S. Centers for Medicare and Medicaid Services (CMS Final FY 2010 Rule) focuses on improving stroke patient care in hospitals. Beginning 2010, hospitals submitting Medicare claims for stroke must let CMS know if they participate in a database registry for stroke care, such as that maintained by the American Heart Association/American Stroke Association's Get With The Guidelines-Stroke (GWTG-Stroke) quality improvement initiative.

The rule also identifies stroke care quality measures hospitals could be required to report for reimbursement beginning in 2012. The same measures have been part of Get With The Guideline-Stroke since 2001.

Lee H. Schwamm, M.D., chair of the GWTG National Steering Committee and director of the TeleStroke and Acute Stroke Services at Massachusetts General Hospital in Boston, says the final rule incorporates what the American Heart Association has long advocated as important for improving stroke care at the nation's hospitals.

"CMS has a series of measurements that they require hospitals to provide in order to receive increased reimbursement under a program called Reporting of Hospital Quality Data for Annual Payment Update," Schwamm said. "Prior to this August, there were no measures that were specific for stroke, which is the third largest killer in the United States and one of the major causes of hospitalization."

The American Heart Association has worked with the Centers for Disease Control and Prevention and The Joint Commission to hone in on the most important measures for evidence-based stroke care.

"Basically, these are the things that we all agree should be done for every stroke patient who presents to the hospital -- from patient education to prevention," Schwamm said.

The National Quality Forum, a nonpartisan organization that reviews and endorses measures for use by quality organizations, insurance companies and CMS, has since endorsed eight of the measures and CMS is considering them for future reporting. The measures are:

1. Deep vein thrombosis (DVT) prophylaxis by end of hospital day two
2. Discharged on antithrombotic therapy
3. Patients with atrial fibrillation/flutter receiving anticoagulant therapy
4. Thrombolytic therapy administered
5. Antithrombotic therapy by end of hospital day two
6. Discharged on statin medication
7. Stroke education provided
8. Assessed for rehabilitation

CMS is also considering including a measure of hospital stroke mortality derived from claims data. CMS's attention to stroke mortality is another indication of a new focus on the importance of addressing the quality of stroke care for the Medicare population.

"So, hospitals really need to start understanding how to collect data on stroke care measures and how to improve on them," Schwamm said.

The American Heart Association has been using these and other measures in its GWTG quality improvement program since 2001. The more than 1,400 U.S. hospitals participating in GWTG-Stroke are one step ahead of the ruling, he said.

Schwamm said the CMS rule also presents an ideal opportunity for hospitals not currently participating in Get With The Guidelines-Stroke. Those hospitals that join the initiative by Jan. 1, 2010 will be able to report to CMS that they are participating in a qualifying registry for stroke care.

"Get With The Guidelines-Stroke also offers unsurpassed benchmarking capabilities with its database of more than one million patient records and data clearly show participation in the program can lead to improved patient care," he said.

In a study published earlier this year in Circulation: Journal of the American Heart Association, GWTG-Stroke participation was associated with increased adherence in all stroke performance measures. All hospitals realized markedly improved stroke care, regardless of their size, geography and teaching status, Schwamm said.

"The American Heart Association/American Stroke Association has an outstanding track record of helping hospitals improve on these and other measures for heart disease and stroke, and we look forward to new hospitals joining this initiative as a springboard to successfully deliver improved care to their stroke patients," said Pierre Fayad, M.D., chair of the American Stroke Association Advisory Committee and Reynolds Centennial Professor and chair of the department of neurological sciences at the University of Nebraska Medical Center in Omaha. "The good news for patients is there will now be a new focus on stroke care in all hospitals, which means that additional resources will be devoted both to improving and measuring the outcome of stroke."