As seen in Crain's Chicago Business
Published September 14, 2009
By Mike Colias

Stroke patients are the new prize in Chicago-area hospitals' competition to land the most-lucrative cases.

Edward Hospital showed off a $5-million lab last week that can help remove blood clots from a stroke victim's brain without surgery. Resurrection Health Care is touting the recent designation of its seven local hospitals as certified stroke centers. Rush University Medical Center has doubled its stroke cases, to about 1,000 annually, after luring a big-time neurologist from New York three years ago.

Once a money-loser, stroke care has emerged as an important profit center for some hospitals as they invest in - and insurers pay for - new technologies that improve patient outcomes, such as scans that offer crisp, three-dimensional images of clots and aneurysms in the brain. The advances are spawning the sort of fierce competition for patients that hospitals have been waging for more than two decades in heart care.

"The market for stroke care has evolved considerably because there are so many more tests and treatments available," says Shyam Prabhakaran, head of Rush's stroke program. "I think you'll see more and more medium- to large-sized hospitals try to position themselves to care for as many stroke patients as possible."

Another motivating factor: A new Illinois law that recommends that ambulances bypass hospitals that aren't certified as stroke centers by a national accreditation group. Only 25 of the nearly 100 hospitals in Chicago and the suburbs are "primary stroke centers," which means they have procedures and personnel in place to quickly assess and treat stroke victims. The rest risk losing patients to stroke-certified rivals.

Chicago-area hospitals are certified as "primary stroke centers," according to the Joint Commission.

"Just about every hospital is going to want to become a stroke center, because the last thing they want is an ambulance to drive past their institution," says Anita Halvorsen, director of the neuroscience program at Chicago-based Resurrection.

Many smaller hospitals will probably seek certification partly as a defensive move, experts say. About eight Chicago-area hospitals plan to apply, according to the Midwest chapter of the American Heart Assn.

But for university medical centers and larger community hospitals with the deep pockets to invest in new technology - and the high volumes necessary for a decent return on investment - stroke care has emerged as a money-maker. Average profits on a stroke case range from $2,800 to $4,000, according to Advisory Board Co., a Washington, D.C.-based research firm.

Hospitals' sharpened focus on stroke care coincided with the federal Medicare program's decision to cover some stroke procedures, says Brooke Patten, neurosciences practice leader at Advisory Board. Since 2005, Medicare has increased payments for the use of clot-busting drugs and manual removal of clots using a catheter snaked through a patient's leg arteries and into the brain.

Central DuPage Hospital does those and other tricky procedures under the direction of Harish Shownkeen, an interventional neurologist recruited from Loyola University Medical Center in 2005. The Winfield hospital has spent $8 million on his lab and grown its stroke-patient load fourfold, to 625 annually, since his arrival. It now takes stroke-patient transfers from more than 20 area hospitals.

"The vast majority of stroke patients should end up in a center that has the expertise, technology and personnel to treat them," Dr. Shownkeen says.

Doctors have a small window - less than three hours - to treat stroke patients with a powerful clot-busting drug. Beyond that point, complex interventional techniques like Dr. Shownkeen's are needed. Illinois' new law should boost referrals from newly certified hospitals to more advanced centers like Central DuPage and Edward, which has partnered with neurology specialists from Northwestern Memorial Hospital.

The law is prodding hospitals to adopt the sort of uniform response to stroke victims that have improved outcomes for heart attack patients, such as administering aspirin. Too often, emergency personnel's response can be haphazard, experts say, as doctors administer the clot buster at their own discretion, rather than following a standard checklist, for example.

Since it began gearing up for certification nearly three years ago, Elmhurst Memorial Hospital has seen a drop in the average time it takes to get a CT scan of stroke patients' brains and administer medication. It plans to apply this month and expects ambulances to deliver more stroke victims once it's certified, says Pamela Arnold, vice-president of patient services.
"The more of them you treat, the better you get at it," Ms. Arnold says. "We're happy to serve more patients."