Of all the initiatives in population health and meaningful use of health information technology, few are as simple, affordable and promising as mobile stroke units.

When individuals, often seniors, start suffering stroke symptoms such as slurred speech and one-sided paralysis, the route to treatment usually entails a 911 call, a visit by an ambulance and then transport to hospital for full evaluation and a CT scan. That can take a while, particularly in rural areas.

Tissue plasminogen activator, or tPA, the clot-busting, brain-regeneration treatment, can mean the difference between a full recovery or severe disability for a stroke patient — if it’s administered fast enough, typically within three hours of symptom onset. On average across the nation, it takes a bit more than an hour for ischemic stroke victims to receive tPA.

In greater Cleveland and Houston, a stroke victim’s chance of getting timely tPA is rather better than that, thanks to mobile stroke units being deployed by the Cleveland Clinic and the University of Texas Health Science Center at Houston. These specialized ambulances are equipped with CT scanners and a video link to neurologists who can diagnose a stroke in a person’s driveway and decide whether tPA can be used (the therapy cannot be used in hemorrhagic strokes, which account for about 10-15 percent of all strokes, because it exacerbates bleeding).

Modeled after ambulances in Germany, where in some regions tPA time has been brought down to 40 minutes, mobile stroke units could go a long way towards improving population health in the U.S. — preventing disability and billions of dollars spending on rehabilitation, preserving quality of life, and freeing up space in emergency rooms.

In Cleveland and Houston, the early results are promising enough and the investment costs so modest that it’s worth wondering if Medicare should establish incentives for health systems to use them. Time to tPA is already on CMS’ radar; in 2017 Medicare's inpatient quality reporting program will require a set of metrics on stroke care, including the time to tPA.

“I definitely think it should be looked at,” Stephanie Parker, RN, project manager of UTHealth’s Mobile Stroke Unit, told sister publication Healthcare Finance News.

UTHealth, which launched the nation’s first mobile stroke unit earlier this year, is tracking the costs, benefits and outcomes in a two-year study. “We're at $200,000 just for acute care for every stroke patient,” Parker said. The ambulance costs $500,000, the CT scanner itself costs $360,000, and “it can be easily implemented into any fleet,” she said. “That means it will basically pay for itself by reversing two to three strokes."

“Our first patient was a 30-year old female with basilar artery thrombosis and we treated her within 60 minutes," parker added. "Whereas it would have taken about an hour and a half if she had not been treated on the scene. She's now living independently and she didn't have to go to rehab.”

Peter Rasmussen, MD, director of the Cerebrovascular Center at the Cleveland Clinic said "it would be wonderful if Medicare would incentivize for these units.”

The Cleveland Clinic’s mobile stroke unit started serving Cuyahoga county in March, connected to Cleveland’s 911 dispatch, and may expand it to neighboring counties.

“The mobile stroke unit provides faster time-to-treatment and also reduces costs,” Rasmussen said. “Most of the cost is in the cost of caring, in rehabilitation. The best way to reduce the cost is to introduce treatment as quickly as possible.”

If the Cleveland Clinic and UTHealth show that’s possible, broad adoption of mobile stroke units have the potential to save billions of dollars and many years in quality of life.