Medicare Does NOT Pay For Preventive Care

March 27, 2010 in Health Care "Reform", Health Policy by RangelMD

You want to know how poorly Medicare reimburses primary care doctors? An actual study from 2006 found that 37% of a proper 1st time doctor visit for an older patient was not reimbureseable.

[Lead author Elizabeth Landsverk, MD, geriatrician at the UCSF-affiliated SFVAMC] examined how the time is spent during an elderly patient’s initial visit to the doctor by tape-recording 21 such visits at Mt. Sinai Medical Center in New York. Reviewing the tapes, she logged the time in five-second increments, assigning each increment to one of 23 descriptive categories, such as history-taking, chatting, cognitive assessment, and so on.

Although Medicare reimbursed for a majority of the doctor’s time during an average visit, 37 percent of the time was not reimbursed. Medicare covers time spent on the physical exam, medical history, medication review, and planning of tests and treatments. However, it does not reimburse doctors for discussions of nutrition, exercise, preventive services, health education, or administrative tasks such as acquiring patient information from other sources and coordinating care, Landsverk said.

Discussions and education about nutrition, exercise, smoking cessation, and preventive health measures like screening endoscopy and mammograms is every bit as important as a discussion about which hypertensive medication to use. Though many of these preventative measures like screening for colon or breast cancer may or may not save money, they do save lives, and counseling by physicians on smoking cessation has been proven to work (Cochrane Database Syst Rev. 2006).

So it’s mystifying how the Obama administration and liberals are keen on preventive care and maintaining access to preventive care when Medicare, the countries biggest government health system, does not even pay for it! A small clue may come from Obama’s own web site that mentions preventive care as part of the overall health care reform effort.

Both the House and Senate versions of health insurance reform rest upon the following building blocks: . . Making preventive care completely free – with no co-payments or deductibles.

No co-pays or deductibles and no reimbursement to the physician. That’s about as free as you can get. And it goes along with the liberal-government tradition of handing out unfunded mandates. For a busy physician who tends to loose money with every Medicare visit, the idea of spending additional time on discussion and counseling about preventive care that is specifically not reimbursed is both insulting and laughable and simply is not going to get done.

Part of the problem is that Medicare does not pay for preventive care as part of its dysfunctional and lopsided funding which mostly ignores primary care including medical consultation and counseling and lavishly funds any and every procedure.  Believe it or not, the removal of skin tags and the irrigation of ears to remove wax gets reimbursed while discussions about wellness and preventive care does not.

So what we end up with is a situation where a primary care provider can spend 5 -10 minutes in a detailed conversation about the risk, benefits, and rational behind preventative screening procedures and literally get paid ZERO for their time and effort while an endoscopist will get paid several hundred dollars to perform a screening colonoscopy in about the same amount of time.

Neither does Medicare pay for “administrative tasks such as acquiring patient information from other sources and coordinating care” which is . . or was another key point of health care reform but it didn’t get much face time in the new legislation. This is also a massively important aspect of care that has the potential to improve quality and decrease costs (especially in unnecessary repetition of tests).

Congress should have fixed Medicare before they “reformed” it.

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