Health Business Blog

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

Seductiveness of brain imaging

Today’s Wall St. Journal reports that graphically appealing MRI and PET scan images of the brain seduce us into thinking we understand more than we do. We see the bright red spot on the cocaine user’s brain when he sees a pile of white powder. We see how a chess grandmaster activates certain regions when working on a complex strategy. But it doesn’t mean we understand the underlying activities any better.

In addition to the points made in the Journal, there are some other interesting aspects to this issue:

  • Expensive imaging modalities (MRI and PET in particular) get over used and over reimbursed because they seem to show us something particularly valuable. Sometimes they do and sometimes they don’t. Often there are other ways to get at the same information
  • Most of the studies featured in newspaper and journal articles are performed on very few subjects, and focus on very specific functions and regions rather than trying to understand the brain as a system. The field has not done a good job of building large scale databases that would enable more robust research and integration of results

I’ve been learning about these issues first hand with a client called the Brain Resource Company in Sydney, Australia. They are working to address these issues by forming an international, multi-disciplinary consortium to build a standardized, multi-modality database of the human brain along with tools to mine it. It’s exciting and challenging.

Medicare reform? Don’t hold your breath

Today’s USA Today has a good article on the coming Medicare budget crunch, pointing out the magnitude of the problem and the lack of political will to deal with it.

The steps Congress could take now to restrain Medicare’s growth are politically perilous. Deny end-of-life care? Restrict eligibility? Reduce treatments? Raise costs? No one in Congress is willing to take them on, and there are few options the public might accept.

“Social Security is merely the warm-up for a very big struggle over how to reform Medicare,” says Maya MacGuineas, president of the Committee for a Responsible Federal Budget. She laments that while the Social Security debate is in full throttle among policymakers, Medicare “is a discussion we haven’t even started.”

The article outlines a number of ideas that have been suggested, pointing out that not only would these steps be insufficient to restrain costs, they would also be unacceptable politically (for now).

  • Reducing payments to providers –this has been tried but is usually reversed
  • Increasing out of pocket expenses for seniors –unaffordable for many
  • Reducing the scope of coverage –but we seem to be going the other way with the drug benefit and coverage for expensive treatments such as PET scans for Alzheimer’s
  • Raise the eligibility age –but again we are heading in the opposite direction, with pressure to allow younger people into the program
  • Improve efficiency –by using technology. But this won’t reduce costs, only open up capacity for more billing

Plastic surgery in Russia must be very expensive

According to this morning’s Boston Globe:

Stepping up the hunt for their biggest enemy, Russia’s security services said yesterday they would pay for plastic surgery for anyone who gives information leading to the killing or capture of Chechen warlord Shamil Basayev, on top of the $10 million reward promised.

You’d think someone with $10 million would be able to afford their own medical bills, but even in Russia things are getting expensive.

Rather than capping the Medicare drug benefit, as recently proposed in the Senate, we could win the war on terror by offering a 90 day supply of Nexium in exchange for information on terrorist whereabouts.

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.