Reperfusion treatment was more common among those who were imaged with CTA (13.0%) and CTP (17.6%) compared with those with computed tomography (CT) of the head alone (4.0%; P<0.0001).62 However, when considering implementation of multimodal CT imaging at small or remote-access hospitals, resource availability and realistic expectations for gains in efficiency should be taken into account. 1.6. Telemedicine (Continued) COR LOE New, Revised, or Unchanged It may be useful for government agencies and third-party payers to develop and implement reimbursement schedules for patients with acute stroke that reflect the demanding care and expertise that such patients require to achieve an optimal outcome, regardless of whether they receive a specific medication or procedure. IIb C-EO Recommendation revised from 2013 Stroke Systems of Care. Multiple studies evaluating fibrinolytic therapy and mechanical thrombectomy, alone or in combination, have demonstrated substantial societal economic value for acute stroke treatment across multiple countries. Pre mechanical thrombectomy era data demonstrate that, in the United States, cost savings of approximately US $30 million would be realized if the proportion of all ischemic stroke patients receiving IV alteplase was increased to 8%. This excludes any gain from increased quality-adjusted life-years gained, a source of tremendous additional economic and patient value. Before the implementation of Centers for Medicare & Medicaid Services Diagnosis-Related Group 559 payment in 2005, treatment of acute stroke was economically discouraged at a hospital level because of a high hospital cost-reimbursement ratio. Diagnosis-Related Group 559 favorably altered the cost-reimbursement ratio for stroke care. In a single-hospital study, this ratio decreased from 1.41 (95% CI, 0.98 2.28) before Diagnosis-Related Group 559 to 0.82 (95% CI, 0.66 0.97) after Diagnosis-Related Group 559. The subsequent years corresponded to a period of rapid growth in the number of primary stroke centers and increasing total stroke treatment cases. 