Health Business Blog

Health care business consultant and policy expert David E. Williams share his views

Getting quick help for “mini-strokes”

Transient ischemic attacks (TIAs), which cause stroke-like symptoms that go away after a short time, can be an indication that a major stroke will occur within days. An article in the March 8 issue of Neurology concludes that physicians need to act quickly to investigate these events. As the Los Angeles Times reported,

“We have known for some time that TIAs are often a precursor to a major stroke,” said Dr. Peter Rothwell, a neurologist at Radcliffe Infirmary in Oxford, England. What we haven’t been able to determine is how urgently patients must be assessed following a TIA in order to receive the most effective preventive treatment. This study indicates that the timing of a TIA is critical, and the most effective treatments should be initiated within hours of a TIA in order to prevent a major attack.”

Translating this finding into patient care will require making it easier for patients to gain access to their doctors on short notice. This could increase the likelihood that patients will report TIA symptoms –which can be vague– and get rapid diagnosis and treatment. I’ll bet many people ignore TIAs rather than heading to the ER or attempting to reach their doctor after hours.

Encouraging error reporting

An article in today’s Journal of the American Medical Association (JAMA) reports the results of a survey of hospital CEOs in states with mandatory reporting of errors and public disclosure, states with mandatory reporting but no public disclosure, and states without mandatory reporting.

Not surprisingly, hospital execs prefer not to have public reporting. However it was interesting that 22% of execs in states with public reporting support reporting of the hospital name compared to 4-6% in the other states. Maybe it’s something you get used to.

In a future post I will draw lessons for healthcare from the airline industry’s near miss reporting system.

Neglect of manufacturing in the pharmaceutical industry

Today’s Wall St. Journal describes how quality control problems in pharmaceutical manufacturing plants are causing shortages of critical medicines, including methotrexate, which is used to treat leukemia in children.

For those of us working in the industry, it’s not surprising news. During the 1990s, the pharmaceutical industry focused on marketing and to a lesser extent R&D. Manufacturing was neglected. According to the Pharmaceutical Research and Manufacturers Association of America (PhRMA), from 1990 to 2000 marketing employment grew 57%, R&D 11%, and production/quality control shrank by 1%.

Regulatory agencies are none too happy about the situation, and have been moving more aggressively to cite offending plants and even seize products. The FDA’s Dr. Janet Woodcock has called manufacturing, “the poor stepchild” of the pharmaceutical industry and it’s easy to see why.

Closing the feedback loop

Low-cost cholesterol testing machines that provide results within minutes are allowing doctors to provide feedback to patients while they’re still in the office, according to the Boston Globe. Used well, it could be a powerful motivational tool to help patients understand how medications and lifestyle changes can affect their cholesterol results. It’s even getting to the point where it’s practical to have such machines for home use.

Providing feedback to patients, especially for conditions such as high cholesterol and high blood pressure that the patient can’t feel, is a useful way to help patients take better care of themselves. This is often overlooked in discussions of patient compliance.

HMO’s new cost control technique: patient involvement

Charles Baker, CEO of Harvard Pilgrim Healthcare, has apparently given up on traditional managed care cost control tools. Baker is calling for radical, “disruptive” measures to get patients involved in slowing down medical inflation.

He’d like to see a greater use of high-deductible plans, and more disclosure of cost information to generate competition among providers.

When I saw Baker speak a few months back, I had the distinct impression he was looking for ways to steer patients from the high cost, high reputation Harvard hospitals in Boston to more cost effective community hospitals. That will be tough.

Maybe he should speak with the folks at Sam’s Club about how to unleash the genius of the consumer.