The Silent ADHD Stimulant Non-Responder: A Case For Eliminating Managed Care Whi

  1. Did the
    patient’s response to stimulants change from good to poor or did it start
    out poor and continue that way?
  2. Was
    sleep impaired when treatment started or did the impairment occur after
    treatment started?
  3. Could
    sleep impairment be a treatment-emergent adverse side effect of chronic
    stimulant use?
  4. Is sleep
    impairment an indicator of an ADHD-look-alike condition such as bipolarity
    that would respond more effectively to more targeted solutions earlier?
  5. Is the
    presence of sleep impairment associated with the aggressive behaviors that
    the FDA subcommittee on safety has targeted for examination?
  6. Could
    the sleep impairments be a predictor of the ‘kindling’ phenomenon
    speculated as a potential source of exacerbation of mood instability?

For the
present managed care is not going away. But if this critical issue is to be
addressed it is necessary to eliminate its obstructions to proper professional
collaboration between primary care and sleep specialists. Verist’s system
achieves that by eliminating wasted time and bringing primary care and sleep
specialists together (with teachers and parents) in a secure virtual space. It
streamlines the process according to proven modern workflow principals.

Starting
with the collection of behavioral data, Verist’s TCM online behavioral ratings
streamlines online entry from the school, office or home. Parents and teachers
enter data online. The data drop instantly into an online electronic medical
record. It appears as a set of graphs that convey at-a-glance any clinical
significance as to how at least two teachers and two parents observe one
child’s behaviors in different settings (school and home) at different times. Compliance
to Verist’s TCM online behavioral ratings is managed by Verist. The physician
or his staff enters the patient’s name and phone number online. Verist does the
rest.

In
addition to TCM, Verist coordinates two QbTests. QbTest is a well-validated, FDA-cleared
test that measures a child’s attention and activity. Most payers reimburse for
QbTesting. Reimbursement is managed by Verist. QbTest is a computer-based
combination of a monotonous attentional test and motion analysis. Objective
measures of attention (or inattention) and activity (or hyper and hypoactivity)
are reported in comparison to age and gender-adjusted norms.

Read on
next month the continuation of this interesting topic.

Thank
you for your time in reading this column. There are several parts to this
column so read on in the next issues for further information on this topic. The
author is quite serious about eliminating managed care by competitive
application of traditional, proven process management techniques and measurable
aspects of cost and quality under the active, professional guidance of
physician leaders. Please send comments to: jtaylor@veristmedical.com.