Although mobile stroke units (MSUs) have been proliferating for some time throughout Europe, they have been relatively slow to catch on in the United States, where fewer than a dozen programs are in the early stages of development. The somewhat tepid reception here may have to do with the way such programs are funded.

“The reason why this developed earlier in Europe and is spreading all over the continent rapidly is because they essentially have a single-payer system in Europe, so if a treatment costs more on one end but it saves money on the other end, the single payer views that as a cost-effective system,” explains Matthew Fink, MD. “In our system, the cost of operating the [MSU] is absorbed by the hospital. The insurance companies are not paying for it.”

Nonetheless, Fink notes that for every patient whose stroke is treated or prevented, and then doesn’t have to spend weeks in the hospital and weeks in rehab, there are great savings on the other end. “The way the system is organized, however, the people expending the money are not going to benefit from the savings. Someone else is going to benefit.”

Consequently, while there are big savings to be had for society from the more effective treatment and prevention of major strokes, how to make the operation of MSUs cost effective for the entities financing such programs here in the states is yet to be worked out. “It’s a big question, but I think, overall, [MSUs] will save money,” Fink observes, expressing confidence that the financials will eventually fall into place, just as his vision to bring the MSU concept to Manhattan has become reality.

“A lot of people told me that I would never make [the use of an MSU] work in New York City. There were just too many obstacles,” he says. “I said that just isn’t right. We have high population density. We have thousands of people living within a very small geographic footprint. This is the perfect city to do this.”

Like the program in New York City, the MSU program at the University of Tennessee in Memphis is operating with the help of grant funding for the next three years, but investigators anticipate that strong outcomes ultimately will be convincing to hospitals and payers.

“By then, we are hoping that we will have a reimbursement structure in place to be able to continue,” notes Wendy Dusenbury, DNP, APRN, FNP-BC, CNRN, ANVP-BC.