Impaired Speech Adds Costs to Stroke Care

Duh, what would be more useful would be to figure out how get aphasia fixed faster.
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Older individuals who have aphasia after surviving an ischemic stroke have higher costs over the first year than those with intact language function, researchers found.

Average Medicare payments were estimated to be $1,703 higher over the first year in stroke survivors with aphasia (P=0.008), according to Charles Ellis, PhD, of the Medical University of South Carolina in Charleston, and colleagues.

The higher costs appeared to be related to older age, longer lengths of stay, and increased discharge to skilled nursing facilities, the researchers reported online in Stroke: Journal of the American Heart Association.

"These findings in total are significant because clinicians, third-party payers, and medical administrators are all required to develop an accurate picture of the financial burden of post-stroke disorders, as reimbursement dollars for the management of these conditions continue to decrease," they wrote, noting that there are caps on Medicare reimbursement for outpatient rehabilitation services.

"The financial burden of the cap remains a major limiting factor to the access of long-term rehabilitative services for patients with persisting aphasia," they wrote.

Ellis and colleagues performed a retrospective analysis of Medicare beneficiaries in South Carolina who had an ischemic stroke in 2004. Both the stroke and the aphasia were identified through diagnostic codes.

The researchers calculated resource use from six administrative sources -- hospitals, Part B providers, nursing homes, outpatient services, home health, and durable medical equipment.

Of the 3,200 patients identified, 12.4% had post-stroke aphasia. That is lower than in previous reports (21% to 38%), which could indicate undercoding of aphasia in the current study, the researchers noted.

On average, the aphasic patients were older, had more comorbidities, had had more severe strokes, and were more likely to be discharged to a skilled nursing facility.

They had higher total healthcare charges ($54,592 versus $48,960) and total Medicare payments ($20,734 versus $18,683) over the first year (P<0.001 for both) than patients who were not aphasic.

When the Medicare payments were broken down based on the six administrative sources of the data, the only significant difference between the aphasic and nonaphasic patients came in payments to nursing homes ($6,135 versus $4,543, P<0.001).

In adjusted models, aphasia was associated with an 8.5% increase in payments and a 6.5% increase in the total length of stay.

"Longer length of stay in this population contributes to increased costs, thereby increasing the attributable cost of having aphasia," the authors wrote. "In addition, it is believed that patients with higher-order cognitive deficits ... experience longer length of stay because of the greater amount of time it takes to appreciate and remediate their deficits."

They acknowledged some limitations of the study, including the lack of quality measures, the use of an unvalidated proxy measure of stroke severity, and the analysis of cost from the perspective of Medicare only, which does not take into consideration out-of-pocket costs and loss of income related to stroke.