Trendspotter: Preventive Services in Reform Law Benefits Doctors and Patients

September 1, 2010
Ken Terry

While many physicians are opposed to portions of the Affordable Care Act, the provisions related to preventive care will not only help them take better care of their patients, but will also increase their revenues. No matter how you feel about the reform law, you should take advantage of these provisions.

While many physicians are opposed to portions of the Affordable Care Act , the provisions related to preventive care will not only help them take better care of their patients, but will also increase their revenues. No matter how you feel about the reform law, you should take advantage of these provisions.

In an article in The New England Journal of Medicine, Dr. Howard Koh, assistant secretary for health, and Kathleen Sebelius, secretary of U.S. Department of Health and Human Services, explain how these sections of the Affordable Care Act work. First, they note, the law helps patients gain better access to preventive services - not only by expanding insurance coverage, but also by lowering financial barriers to preventive care.

Starting this month, private health plans will be required to cover certain preventive services at no cost to the plan member. These services, endorsed by the U.S. Preventive Services Task Force (USPSTF) and other government advisory bodies and agencies, include screening for breast cancer, cervical cancer, and colorectal cancer, screening for human immunodeficiency virus (HIV) for persons at high risk, alcohol-misuse counseling, depression screening, and immunizations.

Public health programs will also improve prevention coverage over time. Beginning Jan. 1, 2011, Medicare will cover an annual wellness visit, including a health risk assessment and a customized prevention plan. There will be no cost sharing with beneficiaries. Medicare will also add free coverage of some other USPSTF-recommended preventive services. And from 2013 onward, state Medicaid programs that eliminate cost sharing for preventive services recommended by the USPSTF and the Advisory Committee on Immunization Practices will receive enhanced federal matching funds.

The law also authorizes federal grants to small business to help them develop wellness programs for their employees. And the federal government will award new community transformation grants through the states to improve nutrition, increase physical activity, promote smoking cessation and social and emotional wellness, and prioritize strategies to reduce health care disparities.

In addition, Koh and Sebelius note, the statute makes prevention a government priority:

“A newly established National Prevention, Health Promotion, and Public Health Council, involving more than a dozen federal agencies, will develop a prevention and health promotion strategy for the country... A new Prevention and Public Health Fund, with an annual appropriation that begins at $500 million in fiscal year 2010 and increases to $2 billion in fiscal year 2015 and beyond, will invest in a range of prevention and wellness programs administered by the Department of Health and Human Services.”

Ask any large employer, and they will tell you this makes a whole lot of sense. Big employers have been investing in health promotion programs for years, partly because they’re taking financial responsibility for their employees’ health through their self-insured plans. According to a recent survey by the National Business Group on Health, 20 percent of surveyed employers said that wellness initiatives were the most effective tactic to control health costs. That was just behind the 21 percent who said that consumer-directed plans were the most effective strategy. And 19 percent said health promotion programs were the second best approach.

So where do physicians come in? Well, believe it or not, you have a lot of influence on your patients’ health behavior. If you design office systems - perhaps using electronic registries-that track which patients are overdue for preventive care, and bring them into the office, the patient will benefit, and you’ll be paid for an office visit. When health plans have to cover these services without cost sharing, you’ll lose the copayment, but you’ll have more patients asking you for preventive care. The same can be said of Medicare patients who will suddenly be booking annual physicals. And once you have patients coming to the office for preventive services, you have an opening to talk to them about their health behavior.

So overall, this portion of the Affordable Care Act is going to be a winner for you and your patients. You may have to invest a bit in systems and staff labor; but if you do it right, you should see a return not only in dollars, but also in patient satisfaction and well-being.