Assessing the "Value" of Stroke Care

Stroke episodes are ideal for assessing the concept of value-based care, a Kentucky team argues.

In an abstract due to be presented April 23 at the American Academy of Neurology meeting in Washington, DC, Michael Dobbs, MD, a University of Kentucky neurologist in Lexington, KY, and colleagues looked at variations in cost-of-care.

They reasoned that if the cost of care differs significantly from one provider to another at the same institution, it will be difficult to control costs.

“An overall positive contribution margin could be severely diminished or erased,” they wrote.

Accordingly, Dobbs and colleagues looked at the costs of care among 6 stroke neurologists at a single comprehensive stroke center.

Those direct care costs, based on 629 cases, varied from $4,951 to $6,144. Including non-stroke physician admissions, the average direct costs per case rose only to $5,923.

This low variability in physicians’ stroke care costs “Is reassuring in an environment of payment reform where hospitals may need to negotiate and share bundled payments for episodes of care,” they wrote. There were many possible reasons why these costs were fairly consistent.

The center had “care pathways’ that were followed by physicians. There were structured handoffs of care. Outcomes and core measures were tracked and reported. Proactive care processes resulted in fewer complications. Further, the team reviewed outlier episodes, mortality cases and readmission. “All team members are accountable for patient outcomes,” the researchers said.

They recommend further studies to validate appropriate ways to control stroke care costs.