Statewide stroke response system narrowed, advanced

Lawmakers narrowed and advanced a bill March 2 that would develop a statewide stroke system of care in Nebraska.

Sen. Roy Baker of Lincoln, sponsor of LB722, said Nebraska needs to address the state’s fragmented care delivery system for stroke victims, especially given that time is an essential component of stroke care.

“[Prompt care] can save the lives of stroke patients and in some patients can reverse neurological damage,” he said. “You can also save significant dollars by avoiding long-term care patient costs.”

Baker said stroke is the fifth leading cause of death in Nebraska and one of the leading causes of disability. Twelve states have adopted comparable legislation, he said, and 17 are considering similar proposals.

As introduced, the bill would require the state Department of Health and Human Services (DHHS) to compile a list of hospitals in the state that meet the criteria to be a comprehensive stroke center, primary care stroke center or acute stroke-ready hospital.

The department would adopt and distribute a nationally recognized, standardized stroke triage assessment tool and develop a plan for achieving continuous quality improvement. The department also would be required to maintain a statewide stroke database.

A task force would be established by DHHS to address matters of triage, treatment and transport of stoke patients. In addition, licensed Emergency Medical Service (EMS) providers would be required to use a stroke triage tool, establish triage and transport protocols and develop training and assessments.

A Health and Human Services Committee amendment, adopted 30-0, narrowed the bill. The amendment removed the following requirements:
• promulgation of rules and regulations by the department;
• maintenance of a statewide database;
• EMS assessment and training; and
• quality improvement planning.

Lincoln Sen. Kathy Campbell, chairperson of the committee, said the requirements were removed due to cost concerns. Campbell said the remaining requirements would benefit patients while not placing an undue burden on hospitals and EMS personnel.

“If you have ever had a family member or a close friend experience a stroke you can understand the importance of the bill that Sen. Baker has brought to you,” she said.

Baker supported the amendment, saying it likely would reduce the bill’s fiscal impact to approximately $100,000.

Continuing to take the first steps toward a complete statewide system remains important, he said, because the level of care that an individual has access to varies greatly depending on where in the state a stroke occurs.

“Not all hospitals in Nebraska are equally prepared to deal with stroke victims in the same manner,” Baker said.

Sen. Merv Riepe of Ralston expressed concerns about the proposal. Calling the bill’s provisions “needless duplication,” he said a well-managed hospital would have adequate standards and transportation plans already in place.

“One of the reasons that we have higher health care costs is that we keep layering more and more things on hospitals,” Riepe said. “That just becomes burdensome and then we try and figure out how we can possibly afford health care.”

Senators voted 29-4 to advance the bill to select file.