Whys and Wherefores

MEDICARE PROPOSES PAYMENT RULE TO PROVIDE NEW PREVENTIVE BENEFITS AND RAISE PHYSICIAN PAYMENTS FOR 2005

“Why, look, dear, Medicare now covers preventive visits.”
“Why, no, dear, not really…Medicare provides a single visit – within 6 months of new enrollment to the program”
“Why that’s not fair! So we don’t get one?”
“Wherefore would you get one now, dear? You’re 72 and you’ve been in Medicare for 7 years.”

Why does Medicare pretend that a one-time “physical exam” is going to improve prevention?

Why does the head of Medicare make a statement such as: “This benefit is particularly important since, according to the Medicare Current Beneficiary Survey, many Medicare beneficiaries do not receive recommended mammograms, pap tests, prostrate screening, flu shots, or pneumonia shots because “they didn’t know it was needed.”” While education is important in preventive service delivery, this statement doesn’t take into account that Medicare frequently DIDN’T PAY for indicated screening examinations. Doctors handled that differently – some would give “rectal bleeding” as a diagnosis to justify a screening colonscopy – even though the rectal bleeding may have happened years ago.

Why is an EKG a mandatory – yes, mandatory – part of a “Welcome to Medicare Exam”?

Why, there ARE some highlights…mandated depression screening and functional ability assessment, emphasis on counseling and education about preventive services, coverage of nutritional counseling for diabetes – although these are haunted by the spectre of a way-too-overloaded office visit.

Why does CMS seem to have so much trouble establishing a true committment to preventive services?