title: A description of Canadian and United States physician reimbursement for thrombolytic therapy administration in acute ischemic stroke.
abstract: OBJECTIVE
  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 dollars (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 dollars 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.
authors.affiliation: Department of Neurology, University of Cincinnati College of Medicine, 231 Albert Sabin Way ML0525, Cincinnati, Ohio 45267-0525, USA. dawn.kleindorfer@uc.edu
authors.forename: Dawn
authors.initials: D
authors.lastname: Kleindorfer
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.forename: Daniel
authors.initials: D
authors.lastname: Woo
authors.forename: Thomas
authors.initials: T
authors.lastname: Tomsick
authors.forename: Arthur
authors.initials: A
authors.lastname: Pancioli
authors.forename: Brett
authors.initials: B
authors.lastname: Kissela
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: David
authors.initials: D
authors.lastname: Losiewicz
authors.forename: Edward
authors.initials: E
authors.lastname: Jauch
authors.forename: Alexander
authors.initials: A
authors.lastname: Schneider
authors.forename: Andrew
authors.initials: A
authors.lastname: Ringer
authors.forename: Daniel
authors.initials: D
authors.lastname: Kanter
authors.forename: Joseph P
authors.initials: JP
authors.lastname: Broderick
mesh_terms: D000416:Alberta; D002170:Canada; D018588:Fee-for-Service Plans / Q000639:trends*; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000191:economics*; D007629:Kentucky; D010820:Physicians / Q000191:economics*; D020521:Stroke / Q000188:drug therapy / Q000191:economics*; D015912:Thrombolytic Therapy / Q000191:economics*; D014481:United States