Call Your Representative to Express concerns About Proposed Stroke Measures

Published July 16, 2013

Please help create a stroke outcome measure that accounts for stroke severity so that hospitals caring for the most severe stroke patients aren't unfairly penalized, health disparities aren't worsened and the work many hospitals have been doing to implement stroke systems of care in our communities and regions aren't undermined.

The Centers for Medicare and Medicaid Services (CMS) has proposed adding two new stroke outcome measures—a 30-day acute ischemic stroke mortality measure and a 30-day acute ischemic stroke hospital readmission measure—to its hospital Inpatient Quality Reporting program, as part of its FY2014 hospital inpatient prospective payment system proposed rule. The American Heart Association/American Stroke Association and many other patient and provider organizations have very serious concerns about CMS's proposal. In addition, neither of these measures have been endorsed by the National Quality Forum (NQF). In fact, the NQF rejected the stroke hospital readmission measure last fall, and CMS withdrew the stroke mortality measure from NQF consideration.

We believe these measures are fatally flawed because they do not adjust for stroke severity—the single most important variable for determining whether a stroke patient has a good outcome or not.  This concern was validated by a paper published in JAMA last summer that found that 58 percent of hospitals would be misclassified if the stroke mortality measure is not adjusted to account for stroke mortality. If these measures aren't fixed before being implemented, they could unfairly penalize hospitals caring for the most severe stroke patients, worsen health disparities, and undermine the work many of us have been doing to implement stroke systems of care in our communities and regions.

The AHA/ASA has been working with the AAN, the Brain Attack Coalition, and national hospital associations to mount a vigorous effort to let CMS know that we oppose adoption of these two stroke measures until they are revised to effectively adjust for stroke severity. However, it has become clear that CMS needs some pressure from Members of Congress to reconsider these measures.

Fortunately, a number of our stroke champions in Congress, Representatives Lois Capps (D-CA) and Chris Smith (R-NJ), have agreed to circulate a letter to CMS on this issue for their colleagues to sign on to. The deadline for Representatives to sign on to this letter is Friday, July 19.

It is critically important that Members of Congress hear from YOU and YOUR HOSPITALS that you would like for them to sign on to the letter to CMS expressing concern about the stroke measures. More specifically, how can you help?

  1. Call your Representative and Senators directly BEFORE July 19th to ask them to sign on to the letter to CMS.  For House Members, this letter is being circulated by Representatives Capps and Chris Smith. For Senators, ask them to contact CMS to express their concern about the stroke measures. 

    If you're not sure who your representative or senators are or need their phone numbers, you can find this information on the AHA's You're the Cure website by typing in your zip code.  Making a call to your Members of Congress is effective and easy and there are some talking points attached to help you. 
  2. Talk to the hospital(s) with which you are affiliated and urge officials there to also contact their Representative and Senators about this issue. 

In addition to the talking points mentioned above, AHA/ASA has developed a number of resources to help you.  Attached you will also find a one-page backgrounder on this issue and a copy of the letters being circulated for sign-on by Representatives Capps and Smith.  The one-pager and letter can be shared with your Members of Congress, if their staffers ask for additional information during your phone calls -- and AHA's Advocacy staff (Stephanie Mohl, AHA/ASA Senior Government Relations Advisor, is available to help with any follow-up to the offices that may be needed. 

Thank you in advance for your help bringing this matter to the attention of your lawmakers.

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