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Considering advanced stroke accreditation?

Advanced stroke accreditation has been long seen as a must-have for any stroke program offering interventional services for the treatment of large vessel occlusion (LVO).

There are two main reasons for this belief. First, accreditation standards serve as an organizational tool. Leaders can use the standards to organize and build a high-quality stroke program. Second, advanced accreditation can drive growth. Programs in states that mandate that EMS bypass closer, lower-level centers for patients with suspected LVO will likely capture additional cases. And all programs can seek to use their center of excellence designation to appeal to providers and patients.

We tested this last reason with Medicare FFS data and found that advanced stroke accreditation for thrombectomy-capable stroke centers does not always lead to volume growth.[1] While most hospitals outperformed their markets in the year before they received advanced accreditation, only “earlier movers” saw sustained growth afterwards.

Looking at the mechanical thrombectomy (MT) national market, we identified a group of 19 primary stroke centers (PSC) that either gained thrombectomy-capable or comprehensive stroke center (TSC/CSC) accreditation from the Joint Commission between Q4 2018 and Q1 2019. We then compared the volume trends of this group to 161 TSC and CSC providers.

Growth jumps before advanced accreditation, but quickly returns to market…

Initial jump prior to accreditation. The group of newly accredited providers saw a jump of 66% in MT volumes in the year before they received accreditation. Comparatively, the group of TSC/CSCs grew by 31% and the national market grew by 35%. This adds credence to the idea that advanced certification can serve to organize a program in preparation for accreditation, such as hiring an additional neurointerventionist.

Return to market growth rate following accreditation. In the year after accreditation, the growth rate of the newly accredited group fell to mirror the national market growth of 19%.

…Except for earlier movers, who continue to outperform on growth

Further analysis revealed an exception: early movers. We segmented our 19 newly accredited providers into early-, middle-, and late-mover categories based on when they gained accreditation relative to other providers in their hospital referral region.[2][3]

We found an early-mover advantage following accreditation. 75% of early-mover providers outperformed their market’s growth rate in the year after accreditation, compared to 67% of middle-movers and 40% of late-movers. This trend, while less pronounced, also held in the year up to accreditation.

Stroke provider’s mechanical thrombectomy performance in year following accreditation

navigating

As we mentioned earlier, there are other good reasons to pursue accreditation. But if it’s just a means to drive stroke growth, it’s worth considering more direct ways to attract patients given the significant costs associated with accreditation investment.

Sources

[1] Fee-for-Service.

[2] Mover designation based on whether a provider gained accreditation in first, second, or third tercile relative to other mechanical thrombectomy providers in their market. Market providers must have reached a total of 10 volumes across 2013-2019 annualized to be included in the categorization.

[3] Hospital referral regions are geographic markets defined by the referral patterns for tertiary care by Medicare beneficiaries.

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