Page 55 - Layout 1

This is a SEO version of Layout 1. Click here to view full version

« Previous Page Table of Contents Next Page »
healthcarejournalbr.com | July / August 2008 Issue |
Healthcare Journal of Baton Rouge
55
quality and value of the healthcare available to
them through local hospitals. The Hospital
Compare web site currently provides informa-
tion on 26 quality measures, which include
process of care and outcome measures.
Process of care measures report how well a
hospital provides care and outcome measures
reflect the results of the care that beneficiaries
received while in the hospital. With the addition
of the 10 new patient experience of care topics,
consumers will now be able to get a better pic-
ture of the quality of care delivered at their local
hospitals. To access the Hospital Compare
web
site,
please
visit:
www.hospitalcompare.hhs.gov.
Medical Organizations Issue New
Guideline on Drugs to Treat Dementia
The
American College of Physicians (ACP)
and the
American Academy of Family
Physicians (AAFP)
have issued a new guide-
line on current pharmacologic treatment of
dementia. The guideline appears in the March
4, 2008, issue of
Annals of Internal Medicine
,
ACP's flagship journal, and is available online
at www.annals.org. A committee representing
ACP and AAFP reviewed dementia literature
for outcomes such as cognition, global func-
tion, behavior/mood, and quality of life/activi-
ties of daily living–areas of importance to
physicians treating patients. The committee
found that high-quality scientific evidence was
limited and so developed cautious recommen-
dations:
1. Clinicians should base the decision to try
therapy with the
FDA
approved drugs for
dementia on an individualized assessment of
the patient.
2. Clinicians should base the choice of drugs
on tolerability, adverse effect profile, ease of
use, and cost of medication.
3. Further research is urgently needed to
address gaps in knowledge about the clinical
effectiveness of pharmacologic management
of dementia.
Currently five drugs are approved by the FDA
for dementia: four acetylcholinesterase
inhibitors [donepezil (Aricept®), galantamine
(Razadyne™, Reminyl™, Nivalin), rivastigmine
(Exelon), and tacrine], and one neuropeptide-
modifying agent [memantine (Mamenda®)].
These drugs do not cure dementia (there is no
cure at this time) or repair brain damage. They
may improve symptoms or slow down the dis-
ease. The guideline also outlines research that
needs to be done:
•Evaluate the appropriate duration of therapy.
•Test drugs head-to-head.
•Test drugs in combination therapy.
One reason for the urgent call for research is
the deficiencies found in the existing medical
literature. The ACP-AAFP committee found
that most of the existing studies focused on
statistical significance of changes, but patients
with dementia, caregivers, and physicians are
more interested in clinically important improve-
ment. In summary, no convincing evidence
demonstrated that one therapeutic treatment is
more effective than another, the committee
concluded.
Medicare Acts to Reduce
the Number of
Yearly Drug Plan Reassignments
The
Centers for Medicare & Medicaid
Services (CMS)
has issued a final regulation
that could allow nearly one million Medicare
beneficiaries with limited income and
resources to remain in the Medicare prescrip-
tion drug plan in which they are enrolled with-
out having to pay a premium. The new rules
apply to people with Medicare who are eligible
for Medicare's extra help program, the low-
income subsidy (LIS) provided under the Part
D prescription drug program. Currently, LIS
beneficiaries who are enrolled in prescription
drug plans that no longer offer a zero-premium
plan, and who have not made an affirmative
choice to change plans, are reassigned by
Medicare to a different prescription drug plan in
their region that offers coverage with no premi-
um.
The final rule changes the way that Medicare
will calculate the regional low-income subsidy
benchmarks, based on comments received on
the proposed rule issued in January. The LIS
benchmarks reflect the amount of a plan's pre-
mium that will be paid by the Federal govern-
ment through the low-income subsidy. For
example, the Federal government pays up to
100 percent of the Part D premium for LIS ben-
eficiaries who are in plans with premiums
below the regional LIS benchmark. Lower low-
income subsidy benchmarks mean that there
are fewer plans that offer low or zero-premiums
for low-income subsidy beneficiaries. That
results in more beneficiaries being reassigned
to other plans.
Under the final rule, these benchmarks will be
weighted based on each plan's share of
enrollees receiving the low-income subsidy,
rather than their share of total Part D enroll-
ment. This means plans with a greater number
of low-income subsidy enrollees will be a larg-
er factor when CMS calculates the benchmark.
This will help to ensure that the premium sub-
sidy amount better reflects the plans that low-
income subsidy beneficiaries are enrolled in.
This will result in fewer LIS beneficiaries seeing
their drug coverage disrupted by having to
change prescription drug plans in order to
avoid paying a premium. For example, if this
regulation had been in place for 2008, the num-
ber of reassignments would have been
reduced by 850,000. The final rule went into
effect May 31, 2008. The rule can be read
online and will be available at:
http://www.cms.hhs.gov/PrescriptionDrugCov
Contra/downloads/CMS4133F.pdf.
Diverse Populations
Pose Special Health Needs
As the face of America continues to change, a
research report released by
The Joint
Commission
, entitled “One Size Does Not Fit
All: Meeting the Health Care Needs of Diverse
Populations,” urges healthcare organizations
to assess their capacity to meet patients'
unique cultural and language needs. In its
2001 report “Crossing the Quality Chasm,” the
Institute of Medicine
identified patient-cen-
tered and equitable care as important elements
of quality. The new report is based on success-
ful practices now being used in hospitals, and
underscores the need to move away from a
“one size fits all” approach that negatively
affects the quality and safety of care for diverse
1938:
Electroshock therapy is introduced
based on observations at a slaughter-
house. Heredity is thought to be a factor in
schizophrenia.
1939:
The mentally ill are among those considered bio-
logically unfit by Hitler. Approximately 270,000 mentally
ill patients are murdered by medical personnel in accor-
dance with racial purity doctrine.