Few seniors are using a much-touted new benefit from Medicare intended to increase preventive health care.
The reason, at least in Central Oregon, may be that few physicians are willing to provide it and those who do say it doesn't meet patient needs.
The benefit, an annual wellness visit that is free to all Medicare recipients, was part of the Patient Protection and Affordable Care Act, the federal health reform law passed in March 2010. Press releases from the federal government said this visit and other enhancements to preventive care could lower costs, prevent illnesses and save lives.
But as of the end of August, only about 4 percent of beneficiaries with original Medicare had used it.
Physicians and practice managers around the area said the requirements imposed by the Centers for Medicare and Medicaid Services are onerous and that the visit does not include often-needed disease maintenance.
Of the area's three largest primary care practices, only one will currently perform the annual wellness visit and that practice said it does so rarely.
Physicians said that one of the biggest problems is confusion over what the visit actually entails. Patients come in expecting a physical exam, the kind common in an annual visit for those with private insurance. But the annual Medicare visit explicitly excludes a physical exam.
“In my opinion, (the benefit) is a very poorly thought out thing,” said Dr. Sean Rogers, medical director at Bend Memorial Clinic. “If a (Medicare) patient were to come in for a wellness visit and an exam, they would be billed for two separate services.”
None of the providers at BMC, one of the largest primary care practices in the area, will conduct a Medicare wellness visit, Rogers said.
Patients also expect to be able to talk about ongoing health issues at the visit, said Dr. Dan Murphy, a primary care physician at St. Charles Family Care in Redmond.
But the wellness visit is not designed to address chronic conditions, he said.
If the physician does follow up or treat chronic medical problems, Murphy said, it is billed differently and typically with a cost to the Medicare beneficiary. Then, Murphy said, “the patient gets angry.”
St. Charles Family Care is one of the only large clinics in the area currently offering the annual wellness exams but Murphy said the clinic is not doing many because of the confusion and hassles.
High Lakes Health Care, another large primary care provider, is not currently providing the service but plans to soon, said Corrina Rottum, a billing coder for the clinic's parent company, Adaugeo Healthcare Solutions.
Rottum said High Lakes has had problems implementing it because of the large number of requirements providers have to fulfill to be paid for the service. “There's so many little bullets that need to be checked off that even if one is not done, you can't bill (the visit) to Medicare.”
Others, too, said the visits were bureaucratically difficult. “It's ridiculously onerous,” said Rogers, noting it was the primary factor in the clinic's decision not to offer the benefit.
As part of each annual Medicare visit, patients get some of the routine measurements, including height, weight and blood pressure. But there are a lot of items that are not typically included in an exam, including an evaluation of possible cognitive impairment, a screen for depression and a list of all screening tests appropriate for the person for the next five to 10 years.
“It would take upwards of an hour to review this stuff with a patient,” said Rogers. He estimated the reimbursement to the clinic from Medicare would be about $150.
Both BMC and St. Charles Family Care said that instead of using the new benefit, they will continue to do what they've always done: See patients for chronic issues and try to deal with preventive care during those visits.
The list of preventive issues addressed in these visits is shorter than what's expected on the wellness visits, said Murphy, but more “real world” in terms of how doctors and patients interact.
“I love the idea that Medicare has decided that ongoing health care maintenance is good,” said Murphy said. “But it was set up in a way that the constraints of the visit are not what most people are accustomed to.”
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