Dr. D practices internal medicine in rural New England. He is vigilant towards signs of memory loss and includes it as a topic on the Medical History forms that all patients complete. He also touches on memory loss in his clinical discussions with each elder patient. Whenever a concern is present, he schedules a follow-up appointment to complete a cognitive assessment using the MCI Screen. In some cases, he will assess a patient’s cognition immediately and bill for both the office visit and the assessment procedure on the same day.
About one quarter of his patients over the age of 65 have some memory deficit with a clear medical cause identified through a subsequent diagnostic work-up. The approximate distribution of clinical diagnoses in his practice is similar to published prevalence figures for the nation:
Possible Alzheimer's disease 43%
Cerebrovascular disease 36%
Alcohol abuse 9%
Traumatic brain injury 4%
Depressive pseudodementia 3%
Metabolic disorders 2%
All others 3%
Interestingly, the majority of his patients with memory loss has not sought medical attention specifically for a memory concern and would not likely have done so until the problem worsened. Dr. D's early intervention is improving patient’s lives and treating memory loss before the underlying problems cause further health problems, degrade the patient's quality of life and progress to less treatable stages.
Dr. S is a neurologist on the west coast and specializes in managing patients with dementia. His patients are primarily referred by primary care physicians in the surrounding community. At each visit, the office assistant administers the MCI Screen and, Dr. S then carefully reviews the patient’s condition with the caregivers. If Alzheimer’s disease is the cause of the dementia, he updates the patient’s disease stage using the FAST Staging tool.
This approach yields many benefits to the patient, the patient’s caregivers, and the practice:
The patient benefits from assessment with state-of-the-art technology that carefully discerns improvements or declines in overall health. This objectively demonstrates treatment effects and reinforces patient compliance with a prescribed treatment regimen. In some cases, when treatment appears ineffective, it alerts Dr. S to the possibility of a misdiagnosis based n a previous workup.
The caregivers benefit from improved knowledge about the patient's stage, the capabilities of a patient in that stage, and what is likely to happen as the stage progresses. This education, enabled by the FAST Staging Tool, greatly reduces caregiver stress and enables better, more informed care.
The practice benefits from the efficiency of leveraging technology to pull important information from raw data on the patient. Furthermore, administration of the MCI Screen and the Depression Screen are reimbursable procedures that require a minimum of direct involvement by Dr. S.
Large Group Practice
Dr. J is the managing partner in a large group practice in the Southwest. Her group is multi-disciplinary and offers full lab and imaging services to the patient population. The practice emphasizes wellness, distributes educational materials liberally, and encourages all patients to be aware of important risk factors based on their individual medical histories. For those who are older, as well as for those with a family history of cognitive problems, a personal history of depression, diabetes, or high vascular risk factors, Dr. J assesses cognition using the MCI Screen at the first suspicion of memory loss.
Once cognitive assessment has been initiated for a given patient, the practice assesses that patient's cognition at every subsequent visit to track changes in memory performance through time. Some "high-functioning" individuals continue to perform well (relative to the public) on cognitive tests even when their memory is clearly faltering from its previous level. Such proactive monitoring of memory offers the best chance of timely intervention against emerging medical conditions that impair memory.
In addition to the obvious health benefits that regular cognitive assessment affords these patients, the group practice has greatly increased revenues from cognitive assessment and, from the lab and imaging work required in a diagnostic assessment for memory loss.
Dr. B is the CEO of a community hospital in the Midwest. The hospital offers community memory screening services that it advertises through the local newspaper and through a newsletter distributed to all households in their demographic target. The service is performed at the "Memory Clinic" on the hospital campus where, in addition to self-referrals from the community, local physicians can refer patients as needed. Appointments are set at fifteen-minute intervals and a hospital staff member uses the MCI Screen to accurately assess a patient's memory. The Memory Clinic is run as a profit center with self-referrals paying a fee and physician referrals generating reimbursement under the hospitalist who oversees the clinic.
The Memory Clinic is a small operation in terms of space and personnel but has been greatly beneficial to the community and to the hospital. Because elders and Baby-Boomers have increasing anxiety about memory disorders and generally feel that appropriate memory assessment services are not available, the presence of this memory clinic has reassured the community that the local hospital is evolving in a direction consistent with their needs. For the hospital, they have identified "strong relations with the aging community" as a key strategic goal and the Memory Clinic has been helpful in that regard. They have garnered effective PR and created a competitive advantage against other regional hospitals with the emergence of a perceived strength in memory assessment. The hospital has also reaped significant economic gains from the referrals sent from the Memory Clinic to the hospital’s Imaging services as part of the recommended guidelines for diagnosing the cause of memory loss.