"We promise according to our hopes, and perform according to our fears."

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Seventeenth Century French author Francois de La Rochefoucauld's philosophical perspective of human nature also encapsulates the reactionary responses to which people will respond to the potential changes in healthcare processes.

First, the FDA surprised the cardiovascular community by issuing its long-awaited approval of prasugrel, which has adopted the brand name Effient. The blood thinner will serve as the only competitor to the blockbuster and current gold-standard Plavix. However, despite enrolling more than 13,500 patients in the TRITON-TIMI trial and enduring a difficult vetting process, a recent Cardiovascular Research Technologies (CRT) poll found that more than half of interventionalists plan to use Effient less than 25 percent of the time. It is unclear whether fears over bleeding risks or concerns about becoming an early adopter are causing this hesitation for physicians.

Interestingly, a fear of increased transparency may cause providers to alter their methodologies. Dr. Harlan Krumholz spoke to Cardiovascular Business News about a new study, of which he was the lead author, that found the mortality and readmission rates associated with heart failure and acute MI had sweeping discrepancies across the U.S. He also pointed out that the rates were unacceptably high, regardless of region and hospital type. However, he said that releasing the statistics of certain poor performers was not meant to threaten or vilify them, but may serve as a catalyst for them to improve their processes.

In this Circulation study, Krumholz and colleagues used publicly-available CMS data on U.S. hospitals, and the agency just updated its Hospital Compare Web site, to include readmission and mortality statistics.

Finally, as healthcare reform becomes closer to reality in Congress -- with the Senate HELP committee approving Senator Ted Kennedy's plan and the House passing their own version of the bill -- people are fearing both tax hikes and employer mandates, as well as government interference.

Ideally, these changes to healthcare will spawn an ideological shift, where people are not scared to perform better, but incentivized and encouraged toward superior patient outcomes.

On these topics, or any others, feel free to contact me.

Justine Cadet