OK

I use the term "Mild Dementia" in this title even though it is obsolete, the current term being MCI or Mild Cognitive Impairment.  The field of senile dementia (also obsolete) is in flux linguistically, legally and scientifically.  And this diary is only discussing one small aspect.

It is a part of AHA, Affordable Health Care Act,  (Obamacare) that few are aware of but will affect all on Medicare.  I wrote three articles about this on my own website, AlRodbell.com the first one entitled A Liberal Considers Obamacare (this particular issue begins in the eight paragraph beginning, "As I was writing this essay...")  The full article and links to the other two are available for those who want an expanded discussion with detailed references.  

What I find objectionable, an understatement of my reaction, is this  "Assessing for cognitive impairment is now mandated as part of the Medicare Annual Wellness Visit."  

I identify my liberal sympathies in my website title since I spent quite a bit of time and emotional effort defending this law against exaggerated accusations.  Since this particular mandate is unknown, it has the tone of being a conspiratorial accusation from Glen Beck or Rush Limbaugh.  I wanted to dispel a reaction based on such an implied source, as this is a specific objection even though it does affect larger financial viability issues as well.      

I'm not close enough to any practicing primary physicians to explore this from their perspective, how they are handling this mandate as described in  The Journal of Family Practice that this assessment of cognitive impairment has been a part of the Medicare Annual Wellness Visit for the last two years.

On the face I take it to mean that even without a formal request, just from conversation with the patient, in order to meet the requirements for billing for this procedure, the cognitive state of the patient must be evaluated.  This is in contrast to another important area, specifically a patient's wishes for end of life care, information that would be invaluable if he/she were to be unable to express such views when in a comatose state.  Yet, this conversation is specifically modified as something a patient may opt out of, as opposed to the cognitive evaluation.

I've done quite a bit of work on this issue, writing to one Alzheimer's researcher, another well know medical ethicist who works in the field of senile dementia--neither of whom have responded; and had a personal conversation with a practicing neurologist who was not aware of this mandate.  My efforts in this area have not all been in vain, as I have made a small but meaningful change in the Alzheimers Association description of normal memory loss.

All comments are welcome, of course.  At this point it would be most useful to know specifically how physicians in the field are treating this mandate.

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