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Missouri cuts funding for program that sped up care for stroke and heart attack victims

Missouri cuts funding for program that sped up care for stroke and heart attack victims

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Health care providers across Missouri are worried about funding cuts to a program that has helped clinicians in their race against the clock in rushing stroke and heart attack patients to the most appropriate facility in the shortest amount of time.

Advocates say the program has helped to improve coordinated care for patients through what is known as the state’s Time Critical Diagnosis System.

The American Heart Association said the program had reduced the time it took to get patients treated, which can lead to better outcomes.

But despite those advances, Gov. Mike Parson vetoed about $150,000 from the program — representing about three full-time staffers — fueling concern about the program’s longevity.

For years, Missouri has operated the program to identify hospitals that can effectively treat stroke and heart attack patients. Hospitals voluntarily seek the designation after meeting certain criteria.

The program was a move away from simply taking patients to the closest facility, instead taking them to the most appropriate facility that can handle seriously ill patients. It’s modeled after the same system for serious traumas.

“The American Heart Association is deeply troubled by this action,” said a letter the association sent July 9 to the director of the Department of Health and Senior Services. “TCD (Time Critical Diagnosis) is doing exactly what it is supposed to do, and we are now concerned these gains could be lost.”

Karen Englert, government relations director for the association, said that in Missouri there was a significant jump over a five-year period in the number of patients who received tPA, a clot-busting drug, and transferred to a larger facility for care. The drug, Englert said, is incredibly effective at preventing long-term disability that can come with strokes.

Englert told the Post-Dispatch her organization was “very surprised to see the cuts.”

Emergency responders are kept up to date on which hospitals are designated as the state’s go-to facilities for heart and stroke victims.

If a hospital is not on the state’s list, emergency crews will bypass the hospital in favor of another. That could become problematic as expiration dates for the designation approach.

“If you had a center 30 miles away and they expire and the next one is 100 miles away, that’s a problem,” said Mark Corley, regional director of Abbott EMS in St. Louis.

Hospitals also are concerned for the program’s future as the system used to store the data shut down earlier this week.

However, Dr. Randall Williams, director of the Department of Health and Senior Services, said that was for maintenance.

The Missouri Hospital Association said it was all sending mixed signals about whether the program would continue and the state’s commitment to it.

“The program is continuing. The governor’s veto was never about the importance of the program. The issue is over the funding of the program,” Williams told the Post-Dispatch.

But cutting about $150,000 from a much larger budget of $1.4 billion budget is raising eyebrows.

“It’s stepping over a dollar to pick up a dime,” Englert said.

Williams said it was about creating buy-in and having hospitals pay a nominal fee to support the program.

The department is proposing that the hospitals that have received a level 1 or 2 designation — typically larger, urban hospitals — pay a fee to subsidize the hospitals at levels 3 and 4, typically smaller or rural hospitals. The goal would be to exempt smaller or rural hospitals from paying anything.

“We greatly appreciate the hospitals and EMS working together because we think this is a very helpful service to the people of Missouri,” Williams said.

Advocates and providers plan to voice their concern about the cuts at a budget hearing Tuesday in Jefferson City.

Samantha Liss • 314-340-8017

@samanthann on Twitter

sliss@post-dispatch.com

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