Leaders shouldn't neglect the business case, which is also important, cautions Shepard.
"It's not the size of the hospital, but a limiting factor to developing stroke care is having the expertise on the campus," he says. "You need an administrator who can do the appropriate business analysis on what it will cost and the benefit to the patient and to train your staff to monitor and prepare for certification by the Joint Commission."
With significantly smaller volumes than heart attack, neurology is challenging for smaller hospitals, he says, because it's difficult to find experienced administrators.
"From a clinical expertise standpoint, teleneurology helps there, but not necessarily from the business case side. What is the ROI for patient and the hospital?"
More important is dealing with care protocols regardless of stroke center designation, he admits.
"The hospitals that are not certified stroke centers and who have not paid attention to these metrics are going to be challenged if they haven't already started training their quality team," he says.
"While most are already submitting core measures, the stroke stuff is new. You may be able to abstract, but you may not have expertise to be able to improve it. That will be challenging for hospitals that don't specialize in neurosciences."