As a primary physician, I fully understand the wisdom of promoting and practicing disease prevention with my patients. I actually do enjoy this. As a matter of fact I aggressively promote wellness and disease prevention with my own family. Reducing the incidence/prevalence and improving the management of many chronic diseases not only improves the quality and length of lives, but also reduces long-term costs to individuals and our economy as a whole.
Medicare, Medicare Advantage, Medicaid and many insurance companies are increasingly urging primary care physicians to perform many screenings tests on a regular basis for the reasons mentioned. The list is long. Here is a summary of procedures that Medicare/Medicaid and health insurance companies are requesting primary care physicians to perform and monitor periodically.
Recommended Screenings (Healthcare Effectiveness Data and Information Set -HEDIS) requested by Medicare and Medicare Advantage insurance companies include periodic Adult BMI Assessment, Influenza Vaccine, Pneumococcal Vaccine, Mammogram, Colonoscopy, Annual Monitoring for Patients on some medications (such as ACE inhibitors, Diuretics), adequate control of Hypertension, Adults Access to Preventive/Ambulatory Health Services, Diabetic Retinal Eye Exam, Glaucoma Exams, DMARDs use in Rheumatoid Arthritis, Cholesterol testing and management in cardiac patients, Diabetic Foot exam, Bone Density Scan, PSA, Hearing tests.
Medicaid HMO HEDIS Program Measure and Standards include mammogram, Cervical Cancer Screening, Chlamydia Screening, Lead Screening, Appropriate Treatment for Children with Upper Respiratory Infection, Avoidance of Antibiotic Treatment in Adults with Acute Bronchitis, Test to Confirm Chronic Obstructive Pulmonary Disease, Use of Appropriate Medications for patients with Asthma, Diabetes Care-Eye exam, Diabetes Care-Kidney Disease Monitoring, Diabetes Care-Cholesterol Screening (LDL-C), Diabetes Care – Blood Sugar Test (HbA1c Test), Well-Child Visits in the First 15 months of Life, Adolescent Visit (Once a year), Preventive Visit Adults (Once a year),Childhood immunizations.
I do realize that good primary medical care should include most if not all of these recommendations for prevention of chronic illnesses and for overall optimum health, regardless of payer requirements. However, it requires significant physician and office medical personnel effort and time to make sure that patients are actually complying with the referrals to get the tests done. It is already very challenging to determine and perform the exact screening procedures needed during an office visit and generating the necessary referrals. Keeping track of patient compliance, acquiring/documenting and reporting the results to the appropriate organizations is a huge and uncompensated workload. The patient is given little responsibility by the payer to be compliant with these procedures. Most of the responsibility is given to the primary doctor. This system needs to be changed. Primary care physicians need much more support to meet these requirements. Some compensation for this work, a lot of which occurs outside the office visit is essential.