Your elderly patient’s family is concerned that driving is no longer safe for this patient. The family wants you to intervene. Can your warnings to the patient make a difference?
Physicians’ warnings to patients who are potentially unfit to drive may contribute to a decrease in subsequent trauma from road crashes, reports a large Canadian study published in the Sept. 27, 2012, edition of the New England Journal of Medicine (NEJM). But the warnings also may exacerbate mood disorders and compromise the patient-physician relationship.
Researchers examined data on patients in Ontario, where beginning in 2006, physicians were offered a financial incentive to warn medically unfit patients against driving. From 2006 through 2009, some 100,000 patients received warnings. The annual rate of crashes per 1,000 patients in which the patient-driver landed in the emergency department (ED) decreased about 45 percent after the warning.
On the downside, however, the study also found that return visits to physicians in the post-warning period decreased and ED visits for depression increased.
It takes time and good communication skills to do an adequate assessment and to convince a patient to turn in the keys. Assuming the patient is covered by Medicare:
- If specific symptoms or complaints prompted the visit, you should report the appropriate evaluation and management code. If counseling is the predominant service in this encounter (i.e., accounting for more than 50 percent of the total face-to-face time), you may select the level of service based on time rather than key components. Be sure to document your time and the counseling you provide.
- If range-of-motion testing is part of your driving assessment, you can bill Medicare for it separately (95831). Medicare does not pay separately for vision screening, health risk assessment, and preventive medicine counseling.
- If the patient is eligible for Medicare’s annual wellness visit, you could include an assessment of driving safety; safety assessment and cognitive and vision screenings are required components of the annual wellness visit.
Here are some resources to help you:
- From the American Medical Association, developed with the National Highway Traffic Safety Administration:
- From TMA: The Older Patient Office Visit: Tips and Techniques (webinar), which offers proven, practical ways to engage elderly patients and their families while managing the office visit effectively — as well as to broach difficult topics like taking away the keys. The webinar also discusses liability issues that are unique to caring for elderly patients.
If you’d like to read the full NEJM article cited above (“Physicians’ Warnings for Unfit Drivers and the Risk of Trauma from Road Crashes”), request an electronic copy from the TMA Knowledge Center at firstname.lastname@example.org.
Published Oct. 17, 2012
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