Blog Post

Should your stroke center become TSC-certified? Here's how to decide.

March 19, 2018

    Until recently, Comprehensive Stroke Centers (CSCs) have monopolized the market for mechanical thrombectomy—a fairly progressive neurointerventional procedure used to treat ischemic stroke. But this is changing partly because of the Joint Commission's new Thrombectomy-Capable Stroke Center (TSC) certification.

    The TSC certification aims to 1) expand access to thrombectomy and 2) recognize the 35% of Primary Stroke Centers (PSCs) that are already offering this procedure safely. This new certification option is particularly important in light of new guidelines that have quadrupled the time window during which patients can receive thrombectomy after stroke.

    In response, many organizations are exploring the TSC-certification process. However, we must caution that TSC certification may not be appropriate for every stroke center, as it requires meeting extensive requirements which could strain hospital resources. If your organization is considering getting TSC certified, ask yourself these four questions:

    1. Is your organization already certified as a PSC? If so, you've got a leg-up.

    Getting a TSC certification is no small feat—but it's more feasible for organizations that are already Primary Stroke Centers. The reason? PSCs have many of the baseline characteristics necessary to qualify for the certification, such as coverage by highly-trained staff and rapid transfer protocols. Remember, the TSC certification is aimed at those organizations that are already capable of offering thrombectomy—not for organizations seeking to offer thrombectomy as a new-in-kind service.

    2. Will you meet the volume requirement for certification?  

    The TSC certification requires organizations to have performed mechanical thrombectomy (as well as the related post-procedure care) for at least 15 patients in the last 12 months or 30 patients over the past 24 months. Although this volume threshold is lower than that required to become a CSC, it still may be prohibitively high, particularly for rural hospitals. Work with your coding or billing department to find your hospital's volumes—if you're not close to these thresholds, TSC certification may not be feasible.

    3. Do you have the investment capital?

    To get certified, all TSCs must have a dedicated neurosurgical ICU as well as 24-hour availability of catheter angiography, MRI scanner, CTA, labs, MRA, and cranial/carotid duplex ultrasound for stroke patients. These requirements are feasible at organizations with high volumes to support the investment, but they may be difficult to meet at hospitals where capital resources are limited. A better option for some organizations might be to adopt a hub-and-spoke model, which centralizes these assets at a TSC-certified main campus and relies on rapid transfer protocols to ensure equal access to advanced stroke services for all patients in the region.

    4. Can you provide around-the-clock stroke care?

    The TSC certification also requires that an acute stroke team and a neurointerventionalist both be available 24/7 (either in person or virtually). In addition, centers must have 24/7 call coverage staffed by attending neurologists. While some hospitals may have the staff to meet this requirement, they'll need to evaluate the burden it would place on the stroke team. Are you pulling your staff away from other important responsibilities? Are you overextending physicians with expanded call coverage? After all, neurologist burnout is among the highest of all specialties. That said, you should ensure early on that your neurointerventionalists are both interested in and supportive of TSC certification.

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