• Posted January 20, 2026

Hospitals Wrongly Penalized For Life-Saving Stroke Care, Researchers Argue

Hospitals are being inappropriately penalized for lifesaving stroke procedures, due to faulty federal methods for analyzing hospital safety, a new study says.

The measure is intended to assess “failure-to-rescue” — a hospital’s failure to prevent deaths from preventable causes after surgery, researchers said.

But the sort of illnesses tracked by the measure – among them pneumonia, blood clots and shock/cardiac arrest – are likely to occur in stroke patients regardless of treatment, researchers argue in the Journal of Neurointerventional Surgery.

"This metric was designed to identify preventable deaths, but when applied to emergency stroke care, it's flagging unavoidable complications of severe strokes rather than problems with the procedure itself,” said lead researcher Melissa Marie Reider-Demer, a doctor of nursing practice in neurology at UCLA Health.

"The unintended consequence is that hospitals providing excellent stroke care to the sickest patients may appear to have poor safety records,” Reider-Demer said in a news release.

The new study centers on Patient Safety Indicator 04 (PSI 04), which is triggered when patients die from any of five complications following a procedure: pneumonia, blood clots, sepsis, shock/cardiac arrest or gastrointestinal bleeding.

For the study, researchers analyzed data on more than 73,500 patients who underwent a stroke thrombectomy between 2016 and 2019. The procedure removes blood clots that are causing a stroke.

Results showed that PSI 04 occurred in nearly 21% of stroke thrombectomy patients nationally, far higher than the 17 other patient safety indicators used to measure hospital safety.

By comparison, PSI 04 was flagged in about 14% of all surgical procedures combined.

The research team also evaluated every thrombectomy case flagged by PSI 04 at the UCLA Comprehensive Stroke Center between 2016 and 2018,  and found that:

• All patient deaths were related to complications of the stroke, not the thrombectomy.

• Thrombectomies accounted for about 7% of flags for neurosurgical procedures at the center, even though they represented 1.5% of all neurosurgical procedures.

• No actual preventable safety concerns were raised in even a single case.

Patients arriving with massive strokes are already at high risk for PSI O4 complications, before any treatment has been offered, researchers said.

In addition, stroke patients are already critically ill before their procedure, unlike people undergoing elective surgeries, researchers said. When complications arise, these patients have far less ability to survive them.

"We're essentially penalizing hospitals for trying to save patients who are already dying from stroke," Reider-Demer said. "These procedures give severely affected patients their only chance at survival or functional recovery, but the current metric makes it look like the hospitals are providing poor care."

Inappropriate safety metrics can have dire consequences for patients, researchers noted.

For example, prior research has shown that some heart surgeons cherry-pick healthier patients to protect their performance ratings, limiting access for the sickest patients who need care the most.

"There's a real concern that hospitals might be discouraged from performing thrombectomy on the most severe stroke patients, or that stroke centers with high volumes of critically ill patients could be unfairly penalized in quality ratings and reimbursement," senior researcher Dr. Jeffrey Saver, chair of neurology at UCLA Health, said in a news release.

The Centers for Medicaid and Medicare Services has proposed revising PSI 04 to exclude patients with conditions like stroke, researchers noted. But, implementation isn’t planned until the 2027 fiscal year, which begins Oct. 1 of this year.

"This revision makes sense from a clinical perspective," Saver said. "The current metric doesn't identify preventable events in stroke care and has the potential to mislead the public about hospital quality while creating incentives that could harm the sickest patients."

More information

The Cleveland Clinic has more on thrombectomy.

SOURCE: UCLA, news release, Jan. 8, 2026