Devil can be in the details for DME requests

This issue covers topics including requests for durable medical equipment (DME), screening for stages 1 to 3 chronic kidney disease, and diagnosis of meningitis.

Fulfilling Medicare patients' requests for durable medical equipment (DME) can be time-consuming for physicians. New rules under the Affordable Care Act require written documentation before delivery to show why a patient would benefit from certain types of DME, as well as an in-person assessment within the 6-month period before the DME is ordered. Further complicating matters, some DME requests come in without a patient's knowledge or the patient places a DME order without first discussing it with the physician. Our cover story offers more details about DME, as well as suggestions on how to streamline processing of requests in your practice.

Our second main feature takes an in-depth look at screening for stage 1 to 3 chronic kidney disease. Last year, ACP released new clinical guidelines on screening, monitoring, and treating the disorder, with one recommendation stating that asymptomatic patients without risk factors should not be screened. The American Society of Nephrology, however, disagreed. But one thing both groups, and all clinicians, agree on is the need for better criteria to diagnose early chronic kidney disease in adults. Our story looks at the current state of the evidence and guidance and examines what internists need to know about this discussion.

Our Conference Coverage section in this issue is from Digestive Disease Week 2014 and the American Academy of Neurology's annual meeting, held this spring in Chicago and Philadelphia, respectively. Read our feature on an in-depth discussion of colonoscopy and its current and potential future place in screening for colorectal cancer, and learn how telemedicine was used at 13 hospitals across the U.S. to help improve timely stroke care. Also, a neurology expert offers advice on accurately diagnosing and treating meningitis, including tips on how to tell viral and bacterial cases apart.

The College's annual Leadership Day took place in May, allowing ACP physician and medical student members from all over the country to visit Washington, D.C., and make their voices heard. The failure to fix the sustainable growth rate (SGR) was a frequently discussed topic this year, along with physician workforce issues and medical liability reform. Read our story to learn more.

Finally, this issue also profiles Larry Crook, MD, FACP, president and co-founder of the Thai Burma Border Health Initiative, which he started after retiring from 20 years in the Indian Health Service and then working in Thailand as part of Doctors Without Borders. The Initiative focuses on advising and funding local health care workers in Burma and helping them provide care for chronic disease as well as preventive medicine.

Do DME requests take up too much time in your practice? How do you approach screening for early chronic kidney disease? Let us know.


Jennifer Kearney-Strouse