Question: REALITY CHECK: Treatment Options and Who Should Pay Patients and sometimes physicians are often not aware of available treatment options, both novel and traditional. For example, in the treatment of multiple sclerosis (MS), different physicians from around the country are prescribing varying plans of treatment. Some physicians have told me how they have seen patients who walked with the assistance of a walker or cane, even a wheelchair, and leave the hospital without assistance. The problem is, the information, experiences, and successes of physicians from different parts of the country often remain unshared. Thus, physicians are left in the dark about who is doing what and how varying combinations of treatment programs may be helpful to patients. For example, in Florida, a physician described a case of an MS patient who came for wound care treatment utilizing a hyperbaric chamber. There was an unexpected side effect, however: the patient, who had arrived in a wheelchair, left with a cane. The physician gives credit to the hyperbaric chamber. If it had not been for the need of wound care, the patient would not have had the unexpected secondary benefit in improving MS symptoms. Unfortunately, health insurance would not have covered the patient's care in the hyperbaric chamber if it had not been for the patient's need for wound care. In New Jersey, a physician described his development of a "cocktail of medications" for MS patients, but insurance does not want to pay for the multiple drugs. A physical therapist in New Hampshire described a new piece of equipment that has helped both MS patients and stroke victims walk again without the assistance of a cane.

1. Discuss why you believe insurance carriers are often reluctant to pay for a variety of treatment options (e.g., lack of sufficient medical evidence that would justify the expense associated with a particular treatment).

2. Discuss why a computerized treatment option database would be a valuable tool when developing a patient's treatment plan.