Study: Healthcare can align Medicare with preventive care
Healthcare reform should be able to bridge the gap between the recommendations of the U.S. Preventive Services Task Force (USPSTF) and Medicare coverage for those services, according to a study published in the January/February issue of Annals of Family Medicine.
“By expanding coverage for the preventive health visit, the healthcare reform law provides avenues to align Medicare payments with the recommendations of the USPSTF, and for better coordination between screenings and clinical services,” wrote lead author Lenard Lesser, MD, family physician and researcher with the Robert Wood Johnson Foundation Clinical Scholars at the University of California, Los Angeles (UCLA). “For these reforms to be effective, however, Medicare beneficiaries must take advantage of the expanded coverage and get their annual check-ups.”
Prior to January, Medicare covered one preventive health visit, the Welcome to Medicare Visit (WMV), within the first year, according to Lesser and colleagues. “Reimbursement for this visit comprised the majority of coverage for preventive coordination under Medicare but has been largely underutilized with only 6 percent of beneficiaries actually receiving a WMV. The healthcare reform law expanded coverage to an annual wellness visit covering several aspects of prevention, including an assessment of risk for disease and developing a personalized prevention plan.”
The researchers sought to examine how well the task force’s recommendations were aligned with Medicare coverage before implementation of healthcare reform. They looked at the services that USPSTF recommended (these have an A- or B-rated) as well as those the task force did not recommend (D-rated) and then divided Medicare coverage for those services into two delivery components: preventive coordination, which includes risk assessment and arranging for appropriate services, and the preventive service itself, which includes the actual testing as well as counseling.
Services rated A by the USPSTF for adults over the age of 65 include screenings for cervical cancer, colon cancer, high blood pressure, lipid disorders for men and for women (each listed separately) and tobacco use.
B-rated services comprise screenings for abdominal aortic aneurysm, alcohol (counseling also included), breast cancer genetic risk, depression, diabetes, obesity (also counseling) and osteoporosis as well as mammograms and counseling for a healthy diet.
The researchers found that of the 15 recommended preventive interventions for these older adults, only one--abdominal aortic aneurysms—was fully covered by Medicare for both coordination and service. Most of the rest received either partial funding on one side and full on the other, or only partial funding for each. For instance, osteoporosis services (i.e. getting a bone density scan) were fully funded while risk assessment and other elements of coordination were only partially funded, and depression services and coordination each got only partial funding.
In addition, Medicare reimbursed clinicians for 44 percent of the non-recommended services, spending valuable tax dollars on unsupported healthcare services, according to the authors. These non-recommended, but covered services, included screening for cervical cancer in women who no longer need screening, ovarian cancer, colon cancer in those older than 85, and heart disease screening in those who are at lower risk.
“Although the healthcare reform law provides new initiatives to improve the delivery of preventive services, it is now up to Medicare to align itself with the USPSTF recommendations and usher in an era of improved quality of care through effective prevention,” the authors concluded.
“By expanding coverage for the preventive health visit, the healthcare reform law provides avenues to align Medicare payments with the recommendations of the USPSTF, and for better coordination between screenings and clinical services,” wrote lead author Lenard Lesser, MD, family physician and researcher with the Robert Wood Johnson Foundation Clinical Scholars at the University of California, Los Angeles (UCLA). “For these reforms to be effective, however, Medicare beneficiaries must take advantage of the expanded coverage and get their annual check-ups.”
Prior to January, Medicare covered one preventive health visit, the Welcome to Medicare Visit (WMV), within the first year, according to Lesser and colleagues. “Reimbursement for this visit comprised the majority of coverage for preventive coordination under Medicare but has been largely underutilized with only 6 percent of beneficiaries actually receiving a WMV. The healthcare reform law expanded coverage to an annual wellness visit covering several aspects of prevention, including an assessment of risk for disease and developing a personalized prevention plan.”
The researchers sought to examine how well the task force’s recommendations were aligned with Medicare coverage before implementation of healthcare reform. They looked at the services that USPSTF recommended (these have an A- or B-rated) as well as those the task force did not recommend (D-rated) and then divided Medicare coverage for those services into two delivery components: preventive coordination, which includes risk assessment and arranging for appropriate services, and the preventive service itself, which includes the actual testing as well as counseling.
Services rated A by the USPSTF for adults over the age of 65 include screenings for cervical cancer, colon cancer, high blood pressure, lipid disorders for men and for women (each listed separately) and tobacco use.
B-rated services comprise screenings for abdominal aortic aneurysm, alcohol (counseling also included), breast cancer genetic risk, depression, diabetes, obesity (also counseling) and osteoporosis as well as mammograms and counseling for a healthy diet.
The researchers found that of the 15 recommended preventive interventions for these older adults, only one--abdominal aortic aneurysms—was fully covered by Medicare for both coordination and service. Most of the rest received either partial funding on one side and full on the other, or only partial funding for each. For instance, osteoporosis services (i.e. getting a bone density scan) were fully funded while risk assessment and other elements of coordination were only partially funded, and depression services and coordination each got only partial funding.
In addition, Medicare reimbursed clinicians for 44 percent of the non-recommended services, spending valuable tax dollars on unsupported healthcare services, according to the authors. These non-recommended, but covered services, included screening for cervical cancer in women who no longer need screening, ovarian cancer, colon cancer in those older than 85, and heart disease screening in those who are at lower risk.
“Although the healthcare reform law provides new initiatives to improve the delivery of preventive services, it is now up to Medicare to align itself with the USPSTF recommendations and usher in an era of improved quality of care through effective prevention,” the authors concluded.