Acute ischemic stroke and transient ischemic attack: A costly business and a strategy to reduce costs (the “Time-Zero” plan)

Managed health care systems and other insurers in the United States are scrutinizing cost-containment measures for acute stroke care. Stroke remains a costly inpatient neurologic disease. Diagnostic technology for stroke has become extremely sophisticated, and the clinician must choose from a broad range of expensive tests. Conflict may arise as stroke patients and caregivers expect a full range of diagnostic tests, whereas primary care physicians strive for the most efficient diagnostic battery and cost containment. The neurologic specialist may find himself or herself caught in the middle of this conflict, frustrated by the apparent failure of the system to satisfy the expectations of providing the highest quality of patient care within cost-containment needs. The “Time-Zero” proposal is a plan to capture both high-quality stroke care and cost containment because common sense must prevail in these times of medical economic uncertainty. Physicians and stroke diagnostic providers must modify their behavior and maintain a flexible approach regarding availability of diagnostic services, whereas insurers must be willing to maintain quality standards to achieve rapid stroke diagnosis and treatment. There is a common ground where patients, physicians, and insurers can 'meet to tackle this challenge. The cost-containment “bottom line” will not mysteriously disappear; thus, we must have a rational plan for stroke diagnosis and treatment that lessens patient, physician, and insurer dissatisfaction.