Health Ministry approves payment to hospitals for stroke patient therapy

Only 7% percent of Israel's 15,000 annual stroke victims are treated in neurology departments that have well-equipped stroke units.

By JUDY SIEGEL-ITZKOVICH
doctor 88 (photo credit: )
doctor 88
(photo credit: )
The country's hospitals will now have incentive to treat strokes effectively to reduce the risk of death and disability in patients, as the Health Ministry has finally agreed that hospitals will receive NIS 26,000 to NIS 60,000 per stroke patient who is suitable for urgent advanced care, including injection of clot busters and brain catheterization. Setting stroke as a diagnostic-related group (DRG) instead of having hospitals receive from health funds only a standard per diem payment for treating stroke patients is expected to encourage hospitals to train and hire experts and open stroke centers. Hadassah University Medical Center Prof. Jose Cohen, one of the country's leading experts in interventional stroke treatment, told The Jerusalem Post on Wednesday that he was overjoyed that after "many years of work" trying to persuade the ministry to change its policy, "hospitals will [finally] receive payment for stroke therapy," which he performed when starting to work at Hadassah in 2001. "I took an elderly... woman suffering from a massive stroke into the angio room to reopen the occluded artery by catheterization. I received an hysterical call from a senior neurologist warning me not to perform the procedure. He told me that what I was going to do was 'experimental'. I did not understand. I had been doing cerebral revascularization procedures since 1997 in Buenos Aires, giving hundreds of talks in scientific meetings about this techniques and was an accepted therapy in a few large hospitals with endovascular capabilities as a lifesaving procedures. Prof. Oded Abramsky, then chief of the neurology department, was one of the firm supporters of these new approaches." Since then, Cohen added, "conservative Israeli neurologists noted scientific evidence of the benefits of this therapy and massively switched to a more interventional approach to stroke, either by the intravenous, intra-arterial or endovascular mechanical approaches." These interventions include injecting patients within a few hours of stroke symptoms a clot-melting drug called tPA to prevent the clots from starving the brain of oxygen and killing nerve cells there, as well as inserting a catheter to open up clogged arteries leading to and inside the brain. Asked to comment, ministry spokeswoman Einav Shimron-Greenboim confirmed the news, saying that three categories of DRGs would be recognized: patients receiving clot-busting tPA to the vein; those undergoing endovascular surgery; and those who don't meet the criteria for these two but who would be hospitalized in the neurosurgery department. Hospitals giving the injections would get NIS 26,311 per patient treated and hospitalized, while those undergoing endovascular surgery would get NIS 60,000. Experts said such treatment is not suited for all types of strokes or all cases, but the new rules are expected to save lives and mobility. "It is good to know that these procedures are going to be recognized and paid accordingly to the hospitals," said Cohen. "This will definitely promote the therapy and will help patients and families. Since 2002 at Hadassah, these procedures were performed based only on our voluntary basis on the belief we are providing the best therapies although no adequate funding was received for years. This was a formal decision of the Hadassah Medical Organization director-general Prof. Shlomo Mor-Yosef, who supported our team actively in our lonely war against stroke." There are only a handful of similar high-level stroke centers in Israeli hospitals, as it hasn't paid for medical centers to invest in them without getting compensated for health funds' members' treatment. Only seven percent of Israel's 15,000 annual stroke victims are treated in neurology departments that have well-equipped and -trained stroke units. NE'EMAN, the voluntary organization of stroke victims and their families, said that there is a "window of opportunity" of about three hours between initial symptoms of a strike - including temporary weakness or paralysis on one side of the body, the inability to speak intelligibly or smile, lack of balance or coordination or disruption of vision - and chances for recovery after sophisticated interventional treatment. The organization's director-general, Pnina Rosenzweig, said that the longer the period of time that passes until treatment, the more likely that the stroke victim will be permanently disabled or die. NE'EMAN recommended the incentive policy to the ministry, and it has now agreed to approve it. NE'EMAN chairman Prof. Natan Borenstein, head of the stroke unit at Tel Aviv Sourasky Medical Center, said interventional treatments increase by 30 percent to 50% the chances of a stroke patient to survive without limitations or with only a minor disability. Even though tPA injections have been available in the US for 12 years and in Israel (at a small number of centers) for four, only 1.6% of stroke victims received them.