Mobile stroke units don't come cheap. Developing a unit costs between $800,000 to $1.2 million. Within 2-3 years, operating and maintenance costs may exceed the initial purchase costs, said Dr. Russman, with most programs running 12 hours a day.
“But there's a cost to not having a mobile stroke unit, including the impact on patient outcomes and additional costs to the health system." said Dr. Russman. With an in-field diagnosis, patients are transported to the most appropriate facility the first time, eliminating all-to-common transfer costs.
To date, much of the work done in a mobile stroke unit hasn't been billable. When it comes to provider reimbursements, the Center for Medicare & Medicaid Services (CMS) has strict rules on originating sites for telehealth, excluding mobile stroke unit telestroke.
“Few mobile stroke units are actually billing for all the services they're providing," said Dr. Russman. Most mobile stroke unit programs absorb the operating, maintenance and non-billable costs through a combination of philanthropy, outside and institutional resources.
However, there's good news on the horizon. Starting in January 2019, legislation will go into effect that directs CMS to begin reimbursing for telestroke, including services coming from a mobile stroke unit point of origin.