Should Preventive Care Be Required For Medicare Patients?

October 9, 2012

Presently, physicians and patients are primarily involved in treatment, not prevention. Is it time to swing the pendulum the other way?

Medicare patients bear little of the expense for their own care. So as a result, they have little incentive to participate in preventive care.

Physicians are not required by CMS to complete a Health Risk Assessment (HRA) or provide wellness visits for their Medicare patients even though they now have substantial reimbursement incentives for doing so.

Private employee health plans often require the regular submission of an HRA and actual participation in health risk prevention programs. Employees are often penalized or even terminated if they do not comply.

Should Medicare patients be offered the option of either an incentive or a penalty, like private employees, to participate in preventive medicine? Should physicians be required to provide wellness and preventive benefits?

Here are proactive suggestions to increase participation for patients and physicians:

1. Medicare patients who complete an HRA and a resulting wellness visit will receive a modest $5 or $10 reduction in their monthly Part B deduction ($60 to $120 a year).

2. Medicare patients who do not participate in at least an annual wellness visit will pay a 5 percent increase in their copays from the standard 20 percent to 25 percent.

3. Physicians that do not complete HRAs and wellness visits for at least 25 percent of their eligible patients would face a scheduled reduction in Medicare reimbursement for all services. (The practice could actually qualify to drop patients who refused, therefore increasing the chance of participation)

It has long been established that reducing copays increases participation in benefits, such as mammograms, flu shots, etc.  CMS eliminated patient copays for the new preventive benefits and wellness visits.

Providing reimbursement without copays is also very attractive to physicians.

The new preventive benefits and especially annual wellness visits have had very little participation. Less than 7 percent of eligible patients last year and not many more this year have completed an HRA. A big problem is that physicians have also not participated. A recent report says 66 percent are ill-prepared to create personalized plans and 71 percent are unprepared to engage patients throughout the year with communications that that help them adhere to their personalized plans.

One often-heard complaint is that patients do not want to come in just to get a wellness visit without actual physician treatment. This can be overcome if physicians would collect the pre-visit HRA electronically and then coordinate the wellness visit with a problem-oriented visit for the patient. Providing both encounters on the same day can generate $250 or more for a 30-minute visit.

The average cost for Medicare patients is now over $9,000 annually and approaching $10,000. Medicare is estimated to be bankrupt in 2021. Reducing treatment expense $1,000 by providing prevention could save $47 billion now and trillions in coming years.

The present system is clearly not working.

Presently, physicians and patients are primarily are involved in treatment, not prevention. Is it time to swing the pendulum the other way?