December/January 2001

News

HCFA Amends Coverage of Biofeedback for Urinary Incontinence

Biofeedback for urinary incontinence may be covered for Medicare patients who have difficulty performing pelvic motion exercises (PME), according to a recent memorandum issued by the Health Care Financing Administration (HCFA). The decision comes after nearly 9 years of deliberation over the effectiveness of the treatment on patients with urinary incontinence.

Medicare’s previous biofeedback policy did not address the use of the treatment for urinary incontinence. Several studies gave inconclusive results about the effectiveness of biofeedback treatment on patients. However, numerous organizations, including the American Physical Therapy Association and the American Urologic Association, support coverage for the treatment.

Swayed by support from the experts, HCFA amended the Coverage Issues Manual 35-27 to read: "Biofeedback therapy is covered for the treatment of stress and/or urge incontinence in patients who failed a documented trial of pelvic muscle exercise training or who are unable to perform pelvic muscle exercises. Contractors may decide whether or not to cover biofeedback as an initial treatment modality."

Urinary incontinence affects 17 million adult Americans. For more information, visit www.hcfa.gov/facts/fs001006.htm.

Research Grant Funds Deep Brain Stimulation Study

To further the study of deep brain stimulation (DBS), the Department of Biomedical Engineering at Case Western Reserve, Cleveland, will receive more than $1.6 million over 5 years from the National Institute of Neurological Disorders and Stroke in the National Institutes of Health. Researchers from Case Western and the Cleveland Clinic Foundation will collaborate to selectively stimulate thalamic neurons in the brain.

DBS is a treatment used for movement disorders such as Parkinson’s disease, essential tremor, and tremor due to multiple sclerosis. "DBS is effective in treating a number of neurological disorders, but the mechanisms of action are unclear," says the project’s principal investigator, Warren M. Grill, PhD, the Elmer L. Lindseth Assistant Professor of Biomedical Engineering at Case Western Reserve University and research scientist at the Louis Stokes Cleveland VA Medical Center.

"We plan to determine exactly which elements of the brain are being activated during DBS," he says, "and then we will develop new technologies to activate them selectively, turning them on and off at will to achieve the desired clinical result." Grill will study the stimulation phenomena on the human thalamus through computer-based neural models. Then he will validate the phenomena in the clinic with new stimulation techniques.

"We attribute some of the complications of DBS to unwanted stimulation," says Erwin Montgomery, MD, a member of the Department of Neurology at the Cleveland Clinic Foundation and codirector of the Center for Functional and Restorative Neuroscience. "If we can improve our ability to target and direct the stimulation, we can expect better therapeutic efficacy and an expanded population of patients who may benefit from the technique."

America Celebrates IDEA

Legislation often comes and goes, but it seems that this idea is here to stay—25 years ago, American legislators passed the Individuals with Disabilities Education Act (IDEA), which concentrates on providing equal access to education for young Americans with disabilities.

America celebrated the 25th anniversary of IDEA on November 29, 2000. IDEA, or PL 94-142, addresses the educational needs of children between the ages of 3 and 21 living with disabilities, while integrating disabled and nondisabled students into the same classroom environment.

Prior to the law, children with disabilities could be shut out of schools or denied appropriate services. IDEA gives these young people access to free public education as well as related services, such as transportation, equipment, and counseling services. IDEA was reauthorized in 1990 and amended in 1997.

States must provide detailed policies and procedures to establish the goal of providing education to children with disabilities, including locating and evaluating children in need of special education. Children are entitled to the least restrictive environment, meaning education in a typical classroom environment to the fullest possible extent. Special classes or separate schooling occurs only if the nature of the disability inhibits the child’s education in regular classes with supplementary aids and services.

Under IDEA, eligible children are evaluated annually by an Individualized Education Program (IEP) team, which is composed of those responsible for the student’s education, including the student’s parents, teachers, and a representative from the school district qualified in special education. The 1997 amendments also include the student’s regular education teacher if the student participates in a typical education environment.

"We have seen tremendous progress over the past 25 years—students with disabilities are graduating from high school, completing college, and entering the competitive workforce in record numbers—and we must continue this progress over the next 25 years and beyond," President Clinton said in a statement on the anniversary of IDEA. "America’s ongoing commitment to this principle, embodied in the IDEA, is both an economic and moral imperative for our future."

Recently, disability advocates observed the 10th anniversary of the Americans with Disabilities Act of 1990 (ADA), which aims to provide equal accessibility to the disabled community in all areas of society. For more information about IDEA, visit www.ed.gov/offices/OSERS/IDEA/.

Health Care Executives Hit Hard in 1999

Irving Levin Associates Inc, New Canaan, Conn, released results of its annual salary survey of top health care executives for 1999. The 1999 survey, which reports salary, bonuses, stock options, and other monetary compensation for the executives of more than 50 companies, showed that 1999 was a challenging year for health care. All but five listed companies reported negative returns for their shareholders in 1999, many with minus-60% or lower, and three prominent nursing home chains filed for bankruptcy. Companies reporting shareholder gains included Advance Paradigm, Apria Healthcare, UnitedHealth Group, Cigna, and HCA-The Healthcare Company. Salaries ranged from the extremes of no compensation to $7.5 million, and 20% of company executives received no bonus.

Shepherd Center Receives SCI Grant

Recognized as a model center for the 18th year in a row, Shepherd Center, Atlanta, will receive a 5-year $1.9-million grant for spinal cord injury research from the National Institute on Disability and Rehabilitation Research of the US Department of Education. Shepherd Center will conduct studies focused on improving patient outcomes, particularly at-risk patients with health, behavioral, or familial issues. The center will also study patients’ recovery from incomplete spinal cord injuries and the onset of secondary complications after discharge.

Presidential Order Focuses on Employment for Disabled Youth

President Clinton amended an executive order to include a focus on young people for the National Task Force on Employment of Adults with Disabilities. The amendment to Executive Order 13078 of March 13, 1998, aims to address education, job training, employment, health, and independence issues for disabled youth. The task force will promote research, increase public awareness, increase access to health care, and encourage more participation of young people in postsecondary education and training programs. To conduct these activities, a Youth Advisory Council, funded and chaired by the Department of Labor, will advise the task force.

Ryan White CARE Act Becomes Law

With Congress’s bipartisan support, S 2311, the "Ryan White CARE Act Amendments of 2000," was signed into law by President Clinton. The act will expand access to care for minorities; establish stronger prevention, diagnosis, and treatment efforts; improve quality of care for HIV patients; and ensure that more patients have access to medications. The program will receive more than $1.7 billion in fiscal year 2001.

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