Doctors certified to use strokebuster don’t

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism.

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.


Image from gandhiji40 via Flickr

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.

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