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Medicare Will Foot the Bill for an Initial Exam at 65
By Robert Pear, The New York Times
July 28, 2004
The Bush administration announced plans on Tuesday to pay for initial comprehensive physical examinations for new Medicare beneficiaries, starting next year, and it said Medicare would also cover screening tests for cholesterol and diabetes for people already in the program.
As a result of incremental changes in the last few years, Medicare now covers a wide variety of preventive services.
The latest changes, authorized by the new Medicare law, take effect on Jan. 1, a year before outpatient drug benefits will become available.
The "welcome to Medicare physical'' for new beneficiaries includes influenza and hepatitis B vaccines, mammograms, Pap smears and pelvic examinations and screening tests for prostate cancer, colon cancer, glaucoma and osteoporosis, among other conditions.
Medicare will cover such services as part of "an initial preventive physical examination'' within six months after a person enrolls in Medicare. Congress assumed that such examinations would help doctors diagnose problems early, when treatment could be more effective.
Many beneficiaries have told federal interviewers that they did not seek such tests and services because they did not think they were needed.
As part of the physical examination, Medicare will also pay for an electrocardiogram; an assessment of a person's risk of depression; hearing and vision tests; and a review of a person's ability to perform activities like bathing, dressing, eating and getting in and out of bed.
Doctors will be expected to ask patients about their diet, their physical and social activities, their work history and any use of alcohol, tobacco or illicit drugs. The government will also pay doctors to provide education and counseling for any medical problems detected in the examination.
While each new beneficiary is entitled to coverage for one comprehensive physical, Medicare will pay for diabetes screening tests twice a year for people who have a high risk of the disease. It will also pay for blood tests every five years to detect cardiovascular disease in people with no apparent symptoms, including analysis of total cholesterol, high density lipoprotein and triglycerides.
In the past, the Medicare law explicitly barred payment for "routine physical checkups.''
Tommy G. Thompson, the secretary of health and human services, said: "Medicare had it backwards, spending 99 percent of its resources treating seniors after they got sick and only 1 percent on preventing illness and promoting wellness. With the new law, we are reversing this trend and focusing more on disease prevention and management."
Doctors and health advocacy groups like the American Cancer Society lobbied for Medicare coverage of routine physical examinations and tests. They welcomed the new benefit on Tuesday, even as they expressed concern about cutbacks in Medicare payments for cancer drugs provided in doctors' offices.
Wendy K. D. Selig, vice president of the American Cancer Society, said: "We are pleased that the administration is moving ahead with coverage of physical examinations. But we are very concerned about proposed changes in reimbursement for cancer chemotherapy in a physician's office and how that will affect patients.''
The Bush administration contends that Medicare has paid far more than market prices for cancer drugs, and that the cuts will be offset by increases in Medicare payments to doctors who administer the drugs.
Deborah Y. Kamin, director of cancer policy at the American Society of Clinical Oncology, rejected that view, saying, "No one believes that the changes in practice expense payments will offset the cuts.''
The administration also announced that Medicare would increase payments to doctors, for services covered under the Medicare fee schedule, by 1.5 percent next year.
Dr. Mark B. McClellan, administrator of the federal Centers for Medicare and Medicaid Services, said payments would have been cut at least 3.6 percent next year if Congress had not taken action to guarantee the increase.
Under rules proposed by the Bush administration on Tuesday, Medicare would make extra "incentive payments'' in areas where doctors are in short supply.
Democrats generally supported the new preventive benefits, but many voted against the Medicare legislation, contending that it was overly generous to insurance and pharmaceutical companies. Senator Bill Frist, the majority leader, said Democrats "tried to block, and ultimately voted against, the most significant improvement in health care for seniors and individuals with disabilities in two generations.''
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