Health plans and physicians should talk to patients about cost-containment bonuses

By Diane Duke Williams

Cost-containment bonuses for physicians trouble patients. So health plans and physicians should address patients' concerns by initiating a dialogue with them, said Thomas H. Gallagher, M.D., in the March/April issue of Health Affairs.

"Health plans and doctors need to take patients' concerns more seriously," said Gallagher, assistant professor of medicine and primary author of the paper. "And we need to figure out how doctors and patients can work together and have conversations about these incentives."

Managed-care plans are providing physicians with new types of financial incentives to encourage more cost-conscious medical care, such as giving bonuses to doctors who have not referred too many patients for specialty care or other services.

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Strength training and hormones Scott Stiever (left), exercise physiologist, coaches Jim Bennett on a weight machine. Bennett, 74, is a participant in a 10-month study evaluating the effects of exercise and DHEA, a hormone that helps strengthen bones and muscles. The study is looking for healthy men and women 65 to 78 years old. For more information, call 362-2396.

Depression affects heart rate after heart attack

By Jim Dryden

School of Medicine investiga- tors have found that depression appears to interfere with the heart's ability to speed up or slow down in response to stress or exertion.

Principal investigator Robert M. Carney, Ph.D., professor of medical psychology in psychiatry, reported at the American Psychosomatic Society's annual meeting March 6, that even after other risk factors such as age, diabetes and smoking were taken into account, depressed heart-attack survivors were significantly more likely than medically comparable patients to have abnormally low variability in heart rate. Lower heart-rate variability is associated with increased risk of heart attack and death.

Heart-rate variability is a good thing --more variability allows your heart to adjust to changes in demand," Carney said. "But we found significantly less variability in depressed patients than in individuals who were medically comparable but not depressed."

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Mild cognitive impairment appears to be Alzheimer's

By Gila Reckess

School of Medicine research- ers have found that most people diagnosed with mild cognitive impairment (MCI) by the school's Memory and Aging Project (MAP) develop Alzheimer's disease in the following years.

The results suggest that MCI, characterized by minor memory loss, is an early stage of Alzheimer's disease rather than a separate disorder.

"We were surprised to find that an unexplained memory deficit currently called MCI almost always turns out to be early Alzheimer's," John C. Morris, M.D., said.

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Volunteers with early signs of memory loss needed

Are you or someone you know having difficulty remembering things? If so, you might be eligible to participate in a study examining memory loss and Alzheimer's disease at the School of Medicine.

Since the late 1970s, researchers at the school's Memory and Aging Project (MAP) have studied the progression of healthy aging compared with Alzheimer's disease and other forms of dementia. With assistance from voluntary participants, they have helped identify early signs and symptoms of dementia and have played an integral part in developing and testing new treatments.

MAP is now looking for more volunteers to help continue its aging and memory research.

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