The Milwaukee Journal Sentinel‘s John Fauber used data from the Joint Commission to discover that a clot-busting drug that could help patients mid-stroke is not being used in between 30 percent and 60 percent of the situations in which it should be effective. It’s a meaty story package, rich in background and context. As always, Fauber did his homework.
The clot-dissolving agent, known as tissue plasminogen activator, or t-PA, is the only approved drug for treating a stroke by stopping it and significantly reducing the risk of disability.
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Yet the number of patients who get t-PA has remained dismally low, about 5% of all stroke patients, ever since the drug was approved 14 years ago. Much of that is because patients fail to recognize their symptoms and get to the hospital within the 4 ½ -hour window during which the drug can be administered.
Fauber writes that part of physicians’ reluctance to deploy t-PA can be attributed to built-in financial disincentives. In a small number of cases it can cause bleeding that might attract malpractice lawsuits, and it’s reimbursed at as low as $200 a use.
As a weird offshoot from this incentivization, Fauber found that the “Primary Stroke Center” certification has enough cachet that physicians while go through the motions of t-PA certification just to get the fancy label, yet have no intention of really using the drug.