Tuesday, March 20, 2007

Medicare-Covered Screening Test for Abdominal Aortic Aneurysm

Abdominal Aortic Aneurysms(AAA) are responsible for 9000 deaths annually in the United States. Normally Medicare does not cover screening test for AAA.

Good news for patients new to Medicare because starting this year(2007) will cover screening Ultrasound test to detect AAA in certain conditions.

I subscribe to the Medicare Newsletter and here is the good news. If you or your love-one is in the high risk group of people to have Abdominal Aortic Aneurysm(AAA), read on. Being aware that you have asymptomatic AAA may save your life. Here is the newsletter from Medicare.


New in 2007 ~ Medicare Now Provides Coverage for a One-time Ultrasound Screening for Abdominal Aortic Aneurysms as Part of the Initial Preventive Physical Examination

The Centers for Medicare & Medicaid Services (CMS) invites you to join with us in promoting awareness of abdominal aortic aneurysms (AAA) and the new screening benefit for the early detection of this disease. Three in four aortic aneurysms are AAAs. Aortic aneurysms account for about 15,000 deaths in the United States annually; of these 9,000 are AAA-related. Men are 5 to 10 times more likely than women to have an AAA and the risk increases with age. Although AAAs may be asymptomatic for years, as many as 1 in 3 eventually rupture if left untreated. [i] [ii] Early diagnosis allows for more effective treatment and cure. Diagnosis of an AAA can be done painlessly with a simple ultrasound scan. Medicare now provides coverage for this screening service for eligible beneficiaries.

Medicare Coverage ~ Effective for dates of service on or after January 1, 2007, Medicare will pay for a one-time ultrasound screening for AAA for beneficiaries who are at risk (has a family history of AAA or is a man age 65 to 75 who has smoked at least 100 cigarettes in his lifetime). Eligible beneficiaries must receive a referral for the screening as a result of their initial preventive physical examination (IPPE) also referred to as the Welcome to Medicare physical exam. There is no Part B deductible. The coinsurance/copayment applies.

IMPORTANT NOTE: Only Medicare beneficiaries who receive a referral for the AAA ultrasound screening as part of the Welcome to Medicare physical exam will be covered for the AAA benefit.

How Can You Help?As a trusted source, your recommendation is the most important factor in increasing the use of preventive services and screenings. CMS needs your help to ensure that patients new to Medicare receive their Welcome to Medicare physical exam within the first six months of their effective date in Medicare Part B and those beneficiaries at risk for AAA receive a referral for the ultrasound screening as part of their Welcome to Medicare physical exam. It could save their lives!

For More InformationFor more information about Medicare's coverage of the AAA benefit, refer to MLN Matters article MM5235 (2006), Implementation of a One-Time Only Ultrasound Screening for Abdominal Aortic Aneurysms (AAA), Resulting from a Referral from an Initial Preventive Physical Examination, located at http://www.cms.hhs.gov/MLNMattersArticles/downloads/MM5235.pdf on the CMS website.

CMS has also developed a variety of educational products and resources to help health care professionals and their staff become familiar with coverage, coding, billing, and reimbursement for all preventive services covered by Medicare.
The MLN Preventive Services Educational Products Web Page provides descriptions and ordering information for all provider specific educational products related to preventive services. The web page is located at http://www.cms.hhs.gov/MLNProducts/35_PreventiveServices.asp on the CMS website.

For information to share with your Medicare patients, visit http://www.medicare.gov/ on the Web.

For more information about Abdominal Aortic Aneurysms, please visit http://www.nhlbi.nih.gov/health/dci/Diseases/arm/arm_what.html on the Web.

Thank you for helping CMS to increase awareness of abdominal aortic aneurysm disease and the new AAA preventive benefit." End of the newsletter.

Call your personal physician right away to find out if you are in the high risk group of patients to harbor asymptomatic(silent) AAA.

Sunday, March 04, 2007

Quit Smoking | Is Nicotine Addiction Real?

I found this interested article and I want to share it with my audience. Also read my comment below after you had read the entire article.

Here is the article:

"I'm a person who walked away from smoking forever about eight months ago and now I can't help but ask this question. I realize that everyone on the television, radio, and internet claims that nicotine is addictive, but is this really true or are they simply trying to get you to buy into the hype so they can get your money? I have to tell you, as a person who smoked for fifteen years and walked away without the aid of any gum, patches, pills, or anything else, I have to tell you that I honestly believe it's all hype!

Really, if it were true and there are actually withdrawals and the like associated with quitting smoking, wouldn't I have experienced some of them? Were there times I wanted a cigarette? Of course, but my conclusion is that it was because I was used to sticking cancer sticks into my pie hole for fifteen years, not because I was addicted to anything. I was just used to smoking. I mean anything that you engage in for 15 years is bound to feel like "normal", right?

The conclusion that I came to is that I wasn't actually addicted to anything and that it was all hype. So I decided not to buy into the hype any longer. Anytime I heard about being addicted or how hard quitting smoking was going to be, I simply said to myself, "I don't believe that, it's going to bee easy to stop." I did this while I was still smoking. When I was by myself smoking, I would look at the cigarette and say the same basic thing directly to the cigarette.

And do you know what. Within a couple of months of doing that, I went in my pack to grab a smoke only to find out that it was my last one. I looked at that cigarette and said, "this is it, I'm done." I proceeded to smoke that cigarette and haven't touched one since that day.

It was literally as simple as that. I've realized that quitting smoking is what you think about quitting and not about being addicted to nicotine. You're addicted to nicotine if you believe that you're addicted to nicotine. It's as simple as that, and if you buy into the hype, you'll believe that you're addicted to nicotine. I'm simply telling you that you're not really addicted to anything you just think you are. You can do exactly what I did and be free of cigarettes and nicotine forever. Unless of course you believe that you can't."

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End of article.

I want to congratulate the author of the-above article and I wish him long-term success in quitting smoking, using the cold-turkey method. Even though the 8-month smoking-free period is too short to predict long-term success, it is still better than those who can not quit at all. Many of my patients had tried this method but only a very had long-term success.

It is proved that nicotine addiction is real. See my previous post at http://realmedicalstories.blogspot.com/2007/01/new-stop-smoking-aids-new-medication.html

The author above is right in being skeptic about the tv., radio and internet claims. My best advice to any one is to consult your personal healthcare provider who has special interest in combating nicotine addiction before jumping into buying into any program of quit-smoking aids. of which hypnosis is one.

This is my 3rd consecutive posts about nicotine addiction. I have been writing Chantix for about at least 2 months now. So far there is one patient on the maintenance pack of Chantix. Two or three patients did not fill the first-month prescription due to various reasons, of which the most common is "I am not ready" Surprisingly, cost is not the mail reason.

Hypnosis is becoming mainstream. The Health System to which I belong is advertising about applying hypnosis as an adjunct in treatment of nicotine addiction and obesity. I will look into hypnosis soon.

Suthin Liptawat,M.D.

Thursday, February 15, 2007

Stop Smoking Aids | Chantix | Hypnosis

It was exactly one month ago that I wrote about nicotine addiction and the new medication Chantix.

Right after that post on this blog, I was able to convince at least 6 of my patients to stop smoking with the help of Chantix. It is too soon to tell about the success but at least they are willing to give it a try. The cost of the medication is not cheap as expected.

Other stop smoking cessation aids should also be considered but it will only add to the cost. One of the popular method is hypnosis.

"Lose weight, quit smoking through hypnosis" is the headline in a small column-advertisement in the current bulletin of St John Health(SJH), in Southeastern Michigan. The cost per session is $69.00.

This means that hypnosis is becoming a mainstream smoking cessation aid. I certainly will recommend this method to my patients in the near future.

By the way, I am a medical staff of a hospital in the SJH system.

One interesting way that I am able to convince patients to stop smoking is comparing the price of Chantix and cigarettes. Two of my patients calculated a one-month cost of smoking a half pack of cigarettes per day at around $100.00. These two patients just finished a 2-year follow up of lung nodules which are stable. Despite the risk of lung cancers staring in they faces, they could not stop smoking until now.

Again, as a disclaimer, consult or discuss with your healthcare provider about smoking cessation aids.

Sunday, January 14, 2007

New Stop Smoking Aids | A New Medication And A Meditation Book

Nicotine addiction is a chronic, relapsing condition. In recent scientific studies, it was found that a specific nicotinic acetylcholine receptor in the brain is responsible for the addictive properties of nicotine.

A new medication, varenicline(Chantix) from Pfizer, looks promising. It's mechanism of action is to prevent nicotine binding to the receptor mentioned above. Since it is so new, time will tell how effective it will be.

More than70% of cigarette smokers want to quit. Most smokers try to quit 6-9 times during their lifetime. Initial quitting is tough but to stay quitting is even tougher.

Besides medication, other smoking cessation aids should be explored and tried.

I have found a book: Keep Quit by Terry A. Rustin,M.D. This is a meditation book providing readers with the motivation and support they need to stop smoking, and the encouragement to stay smoke free each day. Passages give readers insight to the subtle causes for their smoking and ways to deal with those causes without smoking. Learn to break rituals and patterns associated with smoking, such as ways to avoid behaviors, attitudes, and situations that could trigger relapse.

I have put a link on the "books" page of my website.

To go to this page click url: www.competentdoctor.com/Books/html

This is it for now. I will touch other smoking cessation aids in the future.

For my patients who want to quit smoking, this will be my additional weapons to combat their nicotine addiction.

For others: you should mention this to your healthcare providers. You can also find out more information about Chantix at http://www.chantix.com/

Monday, December 25, 2006

Hospital Discharge Medication Error | Blog's Mission

In addition to the original mission, this blog will now serve as a companion blog of my website, http://www.competentdoctor.com/

The original mission is to tell real medical stories and inform visitors about medical errors and medical errors reduction strategies. This mission still stands.

One frequent medical or medication error at the time of a patient's discharge from a hospital's The Discharge Instructions about Medications.

Most patients before being admitted to a hospital are on several medications and most of them neglect to take the list or the actual medications to the hospital.

During the hospital stay, a patient's medications can be changed substantially.

At the time of discharge, most physicians in the past will write "continue all meds at home", although now most hospital rule will not allow this type of discharge order but it still happens due to certain hard-headedness, and "I am the boss" mentality of some physicians.

Recently a patient of mine, under the care of a a specialist in the hospital, was discharged home with very poor medications instructions. Please notice the instructions is in pleural.Actually there were 2 sets of instructions, one written with the list of medications taken during the hospital stay to be continued at home, and a verbal instruction from the nurse to to continue all the meds at home.

To make matters worse, the patient has Alzheimer's and the caregiver did not question the instructions. Also the caregiver did not call me immediately after discharge. This medications error was found out 7-10 days later at a follow-up visit in my office. By that time the patient was even more confused and could hardly stand up due to overdosage of a few medications. Luckily the patient survived.

The Discharge Medication Sheet must be the one and only instruction. It must list all the medications to be taken, including over the counter ones. The patient must also be informed to continue any medication that the patient was taking before admission.

The communications between the patient, the admitting physician, the nurse and the primary carep hysician, if he or she is not the admitting physician is very crucial to prevent this kind of mistake.

One more very effective measure: The patient or caregiver inform the primary care physician about the discharge medications immediately after discharge and ask which medications to take, to prevent duplication or discard of expensive medications the patient was taking before admission.

The primary care physician must respond to this request professionally and as soon as possible to prevent waste of medications and harm to patient. This is the safeguard to prevent medical errors committed by human almost daily in any hospital.

Monday, November 20, 2006

Medical Error | Prescription Drug Error | To Err Is Human

To err is human, but every effort must be made to reduce prescription drug error which is a common type of medical error.

There are many ways that a medication error can occur due to a prescription error.

Physician Errors:

1) Illegible handwriting causing a pharmacist to dispense the wrong drug, wrong strength of drug, wrong direction, wrong dosage or wrong quantity.

2) Legible handwriting but with wrong strength, wrong direction or wrong quantity.

3) Prescribing medication that patient is allergic to.

Pharmacist Errors:

1) Misread the name of the medication and therefore dispense the wrong medication without cross-checking with the prescribing physician.

2) Changing the strength of the medication without informing the prescribing physician and or the patient. Example: Hydrochlorthiazide(12.5 mg) was prescribed and the direction was for patient to take 1 tablet or 1 capsule a day. The pharmacist dispensed a 50 mg strength and the correct direction to take 1/2 of a tablet was printed correctly on the medication label. The patient who was so used to taking one tablet a day may or will continue to take 1 tablet a day, causing an inadvertent overdosing. This is quite a common error.

3) Guessing physician's handwriting which is illegible.

4) Do not crosscheck with physician about potential error committed by physician.

Patient Errors:

1) Do not read the direction on the label on the bottle of the medication especially when it is a refill.

2) Can not read the medication instruction due to poor eyesight or lack of proper education.

3) Unintentional over or under dosing due to forgetfulness.

4) Increasing or decreasing the dosage for whatever reason without telling the physician.

To Err Is Human! But every effort must be made to minimize prescription error. The physician, pharmacist and patient all play important roles in preventing this kind of error.

The followings are a few suggestions and should be a common practice.

1) The physician must write legibly. Writing the name of the medication in capital letters is a good idea. The strength, dosage and instruction of the medication must be accurate. When in doubt, consult the Physician Desk References(PDR) or other resource.

2) The pharmacist must verify with the ordering physician, if there is any doubt about all aspects of the accuracies of the prescription whether it's a written or a phone order.

3) The patient must read the prescription before leaving the office to spot any error and remind the physician to correct it, if any. If the prescribed medication is not familiar to you, feel free to ask whether you can be allergic to it, if you have history of allergic to certain medications.After the receipt of the prescribed medication from the pharmacist, the patient must read the all the information on the label on the bottle.

The subjects of ePrescription, high-risk medications, mail-order prescriptions and phone-order changes of medication dosage and or instruction deserve to be on another post.

Tuesday, October 10, 2006

Giving Sample Medication | A Source of Medical Error

Medication samples given to patients in medical offices is common thing in this country. This endeavor is very helpful to patients who do not have prescription coverage.

Medical errors can easily be committed in the process of giving patients drug samples. There are many areas that that mistakes can occur:

  • The sample medication has already expired but it has not been discarded for whatever the reason.
  • Wrong strength of the sample medication is given when it contains a combination of 2 medications.. For example, AtacandHCT(16/12.5) is ordered but the staff gives Atacand(16mg.) instead. AtacandHCT(16/12.5) contains 2 medications: Atacand (16 mg.) and hydrochlorthiazide (12.5 mg.)
  • Wrong strength of the sample medication is given even when it is a single medication. For example, Atacand(32mg.) is ordered but the staff gives Atacand(16mg.) instead.
  • The wrong sample medication is given to patient outright.
  • The wrong quantity of sample medication is given. For example, the physicain orders 14 tablets to be given but the staff gives out 7 or 21.
  • Staff gives out sample to patients without the physician's knowledge.
  • Staff takes medication sample for personal use or to give it to others who is not patient of the particular office.

How do we prevent medical errors or potential errors mentioned above?

  • Disciplinary action must be imposed on any staff who who commits any of the errors above. The severity of the disciplinary action will depend on the severity of the infraction or whether any harm has been done to the patient.
  • The patient should be instructed to always read the information on the drug sample package and the written instruction of how to take that particular medication. If the patient notices any discrepancies, he or she will notify the office before taking that medication.

A policy must be instituted in any office to prevent the aforementioned medication errors or
potential errors.

In my office we have such a policy :

  • Physician writes the sample medication order in the office chart,including the name of the medication;its strength and the dosage direction.
  • The first office staff will take the order by doing the following steps:
  1. Pull the sample medication from the storage .
  2. Makes sure that the pulled medication is exactly the one that the doctor order.
  3. Reminds the doctor if it seems that the doctor has ordered the wrong dose or wrong strength.
  4. Writes the expiration date of the medication in the chart next to the doctor's order.
  5. Writes her initial next to the order.
  6. Writes the name, strength, dosage, and expiration date of the medication on a small paper called patient-instruction sheet.
  7. Let a second staff verify and initial in the chart if if every thing is correct and put her initial next to that of the first staff.
  8. Let the doctor double check everything before signing the patient-instruction sheet.
  9. The first or second staff will then check the sample and direction one more time before giving the medication to the patient.
  10. The medication and the patient instruction sheet is then put into a special bag
    which will have the same function as any prescription bottle. This staff will sign another initial on the chart right before giving the sample medication to the patient.
  11. Instructs the patient to keep the sample medication and the instruction sheet together in the bag. One bag will contain one medication.

Penalty for staff who commits an error by not following the above drug-sample policy:

  • Put on probationary status for 3 months. Possible dismissal if another similar error is committed during this probationary period.
  • Outright dismissal if any staff takes drug sample for personal use without the doctor's permission.

This policy has been in effect for more than 20 years. Staffs comes and go due to different reasons but no one has been dismissed due to committing error by not following the policy carefully. There were a few incidents of probation. On paper, it looks cumbersome but it becomes second nature for my staff in a very short time, with good supervision for new satff.

In conclusion, this policy works.