Get Those Tests --Medicare Helps Pay




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Get Those Tests --Medicare Helps Pay

By Kelly Greene, The Wall Street Journal
October 28, 2003

Medicare pays for a lot of preventive health-care measures that people aren't using.

About 30% of Medicare patients didn't get a flu shot in 2000. And 37% had never been vaccinated against pneumonia, even though both shots are among the most basic preventive measures for older people -- and both are covered by Medicare . Those were among the findings released this month by the General Accounting Office, the investigative arm of Congress.

The numbers are significant, considering that about 36,000 people die in the U.S. every year from flu and 114,000 are hospitalized -- with an estimated 90% of both categories age 65 or older, according to the Centers for Disease Control and Prevention in Atlanta .

The GAO found that only 10% of female Medicare beneficiaries were screened for cervical, breast and colon cancer and immunized against flu and pneumonia, even though all those tests are covered under Medicare and recommended for older women by the U.S. Preventive Services Task Force, an independent panel of experts sponsored by the federal Agency for Healthcare Research and Quality, Rockville, Md. (The task force dropped its recommendation for cervical-cancer screening for older women this year.)

Many Medicare patients aren't even watching their cholesterol or blood pressure. In a CDC survey that included medical exams, 32% of Medicare patients found to have high cholesterol said they had received no warning from a doctor or any other medical professional that they might have that condition. Likewise, 32% of those found to have high blood pressure had never been told they might have it.

Managed care, with its emphasis on prevention, might seem to be the answer. But the GAO says that "no clear 'best-practice' approach to delivering preventive care stands out" in the managed Medicare plans in which 14% of beneficiaries are enrolled.

Although Medicare patients aren't getting much screening, they're spending time at the doctor's office. Nearly nine in 10 visited their physicians in 2000, with Medicare patients making six visits a year, on average.

"You've got them in the office, and only 30% are getting a flu shot? We still don't have enough doctors thinking about prevention," says Barbara Kennelly, president of the National Committee to Preserve Social Security and Medicare in Washington .

One reason for the piecemeal delivery of preventive care: Medicare currently doesn't pay for an initial, comprehensive exam or regular "non-illness" visits. Doctors typically sprinkle in tests and shots with treatment for other ills. Robert Hayes, president of the Medicare Rights Center , says the New York advocacy group supports creation of a "welcome to Medicare " exam with a doctor followed by an annual review of preventive measures by a non-doctor professional; this "would be reasonably inexpensive and tremendously helpful."

The Centers for Medicare and Medicaid Services, the federal agency that manages the program, is developing ways to improve preventive-care delivery. But until the agency rolls out something nationwide, the best bet for most patients will be keeping track of recommended immunizations and tests themselves -- and making sure they know what Medicare will provide. There's a comprehensive list of screening guidelines at www.ahcpr.gov/ppip/50plus/.