The Impact of the Regulatory & Financial Environment on Stroke Program Growth

Updated on October 7, 2015

Stacey 2013By Stacey Lang, VP
Corazon, Inc.

In 2002, Florida became the first state in the country to implement a formal process for the review and certification of hospital stroke programs. Since that time, the number of programs certified nationally as has increased exponentially, to at present more than 1,200.  These “Primary” programs have demonstrated that certain knowledge, processes, and infrastructure are necessary to ensure that the organization is capable of administering intravenous clot-busting drugs, as well as providing inpatient medical management for these patients.  The certification process verifies these components are in place…

Meanwhile, over 100 hospitals nationally have been certified as Comprehensive Centers. These programs, many of them academic tertiary centers, have all of the components associated with Primary centers, as well as the ability to provide intra-arterial therapies, catheter based neuro-interventional treatments, and open intracranial neurosurgical procedures. 

Most recently, a third designation has been developed by the main national certifying bodies: Stroke Ready. These hospitals are categorized as having the ability to rapidly triage emergent stroke patients, provide intravenous clot busting drugs when indicated, and then transfer the patient to a tertiary partner for continuing care.

At present, 23 states have bypass regulations in place requiring pre-hospital providers to transport any patients suspected of having a stroke to a certified Primary stroke center.  However, presenting symptoms for stroke many times closely mirror those of other conditions. As a result, hospitals that are not certified as stroke centers are at risk for bypass by EMS for a broad patient population—patients who may have stroke or another condition.  Syncope, altered mental status, loss of consciousness, all would be considered presenting symptoms that would require bypass.

And while state and national bypass regulations are increasing, at present, there are no bypass requirements in place for Comprehensive Centers, though the number of hospitals capable of providing comprehensive stroke care far exceeds the number of Comprehensive Centers that have been officially certified.

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Savvy, forward-thinking organizations have long recognized the need to invest in the development of internal systems necessary for stroke care, but only recently has the additional potential of this patient population become top of mind. While initial evaluation and appropriate treatment is key to successful outcomes, providing the additional treatments and services required for these patients presents an excellent opportunity for a comprehensive program with the added benefit of enhanced revenue capture.  While great progress has been made, great opportunity continues to be untapped by organizations not prepared to take the additional steps necessary.

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Stroke programs continue to be the cornerstone of neuroscience, a growth area amid some other declining specialties. Neuroscience services represent a high contribution margin, along with increasing demand due to population and technology advancements.  In fact, Neuroscience care is an essential element of trauma, oncology, and sports medicine, to name a few.  While in many ways, advanced neurologic care is in its infancy, there is no question that this period in neuroscience medicine is exciting in terms of rapid advances and an increasingly complex portfolio of treatment options.

The ability to offer even basic neuroscience services beyond stroke care (sleep, spine, simple intracranial procedures, etc.) brands well as a means to resonate with consumers and employers. These expanded services touch all ages, which often evolves these patients into “consumers for life.”   This benefit is also the result of cross pollination of other services or Centers of Excellence (COEs) such as orthopedics, rheumatology, and endocrinology, which can be of significant benefit to an organizations bottom line in both the short- and long-term.

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Expansion of neuroscience offerings following successful development of stroke services (even in the community setting) is not only advised, but necessary to maintain and grow patient volumes…especially in the community setting!  Given the complexity and expansive nature of neuroscience service offerings, however, as well as the significant capital investment required, involving neuroscience experts with  broad based experience in the planning and implementation will provide the greatest opportunity for success. Through honest analysis, and a comprehensive and focused planning effort, successful implementation of key components of a Neuroscience Center of Excellence is entirely within reach.

Corazon offers consulting, recruitment, interim management, and information technology services to hospitals and practices in the heart, vascular, neuro, and orthopedics specialties.  Find Corazon on facebook at or on LinkedIn at  To learn more, call 412-364-8200 or visit To reach the author, email [email protected]

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