letters

EHRs don't fix everything

Compliments on Dr. David Trachtenbarg's fine article "EHRs Fix Everything - and Nine Other Myths" [March 2007]. This article should be required reading for anyone who is considering purchasing an electronic health record (EHR) system. I've owned my practice for less than five years, and I'm already on my second EHR. When residents ask for guidance on purchasing an EHR, reading this article will be my first piece of advice.

Bobby J. Newbell, MD
Hazel Green, Ala.

Welcome to Medicare visit and AAA screening

Kent Moore's article "What's New in Medicare Preventive Benefits" [February 2007] explains that the abdominal aortic aneurysm (AAA) screening benefit for patients age 65 to 75 who have smoked at least 100 cigarettes is available as part of the Welcome to Medicare physical. Isn't it true that patients have only six months from the time they get their Medicare card to have the Welcome to Medicare physical? If so, then this benefit seems limited to those patients between the ages of 65 and 65½. Even then, the screening is available only if we see the patient for a Welcome to Medicare physical and order it at that time. Is this benefit not available for patients who are older than 65½? Is it really only available at the time we see a patient for a Welcome to Medicare physical? I find it limiting and contradictory that Medicare would not provide coverage for AAA screenings for the many people who fall into the high-risk categories listed in the article but never had or wanted the Welcome to Medicare visit.

David Wells, MD
Asheville, N.C.

Author's response:

Medicare coverage of AAA screenings is effective for services furnished on or after Jan. 1, 2007, for qualified beneficiaries who meet the following criteria:

So you are correct, in a sense, that only Medicare beneficiaries who have had a Welcome to Medicare physical and received a referral for the AAA screening as a result of that exam are eligible for the AAA screening (as long as they also meet the other coverage criteria). The rules do not say that the AAA screening must occur in the same time period as the Welcome to Medicare physical, so, theoretically, the AAA screening could be covered after a beneficiary's first six months of eligibility, as long as the screening resulted from a referral at the Welcome to Medicare physical.

I understand your feeling that this policy is overly restrictive. Unfortunately, in this case Medicare policy is dictated by the law that created the benefit (section 5112 of the Deficit Reduction Act of 2005). As such, it would require an act of Congress to change it. I encourage you to share your perspective with your Congressional representatives, which you can do through "Speak Out," the AAFP's Legislative Action Center, online at http://capitol.aafp.org/.

Kent J. Moore
AAFP, Leawood, Kan.

Semiformal attire and a smile

Your article "What Do We Really Know About Patient Satisfaction?" [January 2007] suggested that patients prefer that their doctor wear semiformal attire and a smile. What is "semiformal" attire?

David Bertoncini, MD
South Bend, Ind.

Editor's response:

The study cited in the article defined semiformal attire as a long-sleeved shirt and a tie with dark pants for a male doctor and a blouse with a dark skirt or pants for a female doctor.