AAN Highlights Advance Directives
In the wake of the Terry Schiavo case, the American Academy of Neurology has added information on advance directives to its Web site. “When the Schiavo situation heated up, our president said, 'Why don't we have information about advance directives on our Web site?'” said AAN general counsel Murray Sagszveen. “It was a blinding flash of the obvious.” The site links users to an advance directives tool kit from the American Bar Association site as well as to a site run by the Robert Wood Johnson Foundation that includes information for all 50 states. Neurologists have a special interest in advance directives because “in other specialties, the patient will come in and may be repaired and go home,” Mr. Sagszveen said. “But with neurological diseases, they are all chronic and some are terminal illnesses. So I think neurologists have more interest than others in advance directives.”
New Medicare Wheelchair Policy
Ability to function is the primary criterion in Medicare's new national coverage policy for power wheelchairs and scooters. The criteria look at how well the beneficiary can accomplish activities of daily living such as toileting, grooming, and eating with and without using a wheelchair or other mobility device. The criteria are “part of our efforts to ensure that seniors who need mobility help will get it promptly, and that we are paying appropriately for mobility assistive equipment,” Mark B. McClellan, M.D., administrator of the Centers for Medicare and Medicaid Services said in a statement. The coverage policy is one element in Medicare's year-old effort to improve the coverage, payment, and quality of suppliers for wheelchairs and scooters. That effort was launched after Medicare spending on mobility equipment rose to $1.2 billion annually. Not addressed in the new policy was which specialists will be allowed to prescribe the devices and whether they will need to see the patients face-to-face, two issues of special concern to neurologists (“'Face-to-Face' DME Prescribing Proposal Annoys Neurologists,” CLINICAL NEUROLOGY NEWS, March 2005, p. 33). “While CMS does require adequate documentation to establish that coverage conditions are met, the complexity of the issues indicates this is best addressed in an initiative separate from the [coverage decision],” the agency said in its coverage memo. “In addition, the issues pertaining to who is qualified to do the patient evaluation [are] beyond the scope of this [decision].”
Ads Influence Prescribing
Direct-to-consumer advertisements appear to have an impact on physician prescribing practices, a study by Richard L. Kravitz, M.D., of the University of California, Davis, found (JAMA 2005;293:1995–2002). A total of 152 family physicians and general internists from solo and group practices and health maintenance organizations participated in the study, which focused on advertising for prescription antidepressants. Standardized patients were randomly assigned to make 298 unannounced visits, presenting either with major depression or adjustment disorder with depressed mood. When the patients with depression made a general request for an antidepressant, only 3% of the physicians prescribed paroxetine (Paxil). However, when they asked for the prescription by name, 27% were given a prescription for Paxil. In addition, patients with adjustment disorder symptoms were more likely to receive a prescription for an antidepressant if they made a brand-specific request (55%) vs. a general request (39%).
CMS: Pay for Performance Works
Pay for performance is improving quality of care in hospitals, judging from preliminary findings of a 3-year demonstration project sponsored by the Centers for Medicare and Medicaid Services. The project tracks hospital performance on 34 measures of processes and outcomes of care for five common clinical conditions. Year 1 data from over 270 participating hospitals show that median quality scores improved in all of the clinical areas. For example, scores increased from 64% to 76% for patients with heart failure and from 70% to 80% for patients with pneumonia.