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Kara Z. Bambauer, PhD; S. Claiborne Johnston, MD, PhD; Derek E. Bambauer, JD; Justin A. Zivin, MD, PhD

Arch Neurol. 2006;63:661-664.

Despite the US Food and Drug Administration's approval in 1996, tissue plasminogen activator (tPA) therapy for acute ischemic stroke remains substantially underused. We reviewed 3 potential reasons for low rates of tPA use: poor patient education, physicians' perceived risk of legal liability from negative patient outcomes, and insufficient reimbursement. The recent addition of diagnosis-related grouping code 559 will provide higher payment for stroke patients treated with tPA, creating a natural experiment to examine our third reason.

Author Affiliations: Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (Dr K. Bambauer); Department of Neurology, University of California, San Francisco (Dr Johnston); Berkman Center for Internet & Society, Harvard Law School, Cambridge, Mass (Dr D. Bambauer); Department of Neurology, University of California San Diego, La Jolla (Dr Zivin).

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