MEDICARE EXPANDS PREVENTION COVERAGE

Under the Medicare Modernization Act , beginning Jan. 1, 2005, Medicare would pay for an initial comprehensive physical examination for new beneficiaries, one of a number of preventive services that will be covered under plans announced July 26th by federal officials, the New York Times reports ( http://query.nytimes.com/gst/abstract.html?res=FB0A12F739590C7B8EDDAE0894DC404482). The "welcome to Medicare physical" would include influenza and hepatitis B vaccines, mammograms, Pap smears, pelvic examinations and screening tests for prostate cancer, colon cancer, glaucoma, osteoporosis and other conditions. The examination also would include an electrocardiogram, a mental health assessment, hearing and vision tests and a review of beneficiaries' ability to perform such activities as bathing, dressing, eating and getting in and out of bed. Doctors also would question beneficiaries about their diets, physical and social activities, work histories and use of alcohol, tobacco or illicit drugs. Medicare would cover patient education efforts to address medical problems detected in the examination. New beneficiaries would have to obtain the examination within six months of enrollment. In the past, the Medicare law explicitly barred payment for "routine physical checkups.''

Additional Services

Medicare also would cover twice-yearly diabetes screening tests for high-risk beneficiaries and tests every five years to detect cardiovascular disease in beneficiaries with no outward symptoms (Pear, New York Times, 7/28). The new law also calls for Medicare to reimburse physicians for the extra services and to give doctors a 1.5% across-the-board raise in reimbursement rates, the Boston Herald reports (Heldt Powell, Boston Herald, 7/28).

Officials' Support

Federal officials say the expansion of Medicare coverage could help reduce costs by preventing more serious illnesses in the future, the Times reports. "Medicare had it backwards, spending 99% of its resources treating seniors after they got sick and only 1% on preventing illness and promoting wellness," Health and Human Services Secretary Tommy Thompson said. He added, "With the new law, we are reversing this trend and focusing more on disease prevention and management" ( New York Times, 7/28).

Advocates Respond

Senior activists also applaud the changes but say they do not allay concerns about other changes to Medicare, including the possibility that some beneficiaries will be pushed into health maintenance organizations ( Boston Herald, 7/28).

Wendy Selig, vice president of the American Cancer Society, said, "We are pleased that the administration is moving ahead with coverage of physical examinations. But we are very concerned about proposed changes in reimbursement for cancer chemotherapy in a physician's office and how that will affect patients.'' The Bush administration contends that Medicare has paid far more than market prices for cancer drugs, and that the cuts will be offset by increases in Medicare payments to doctors who administer the drugs . Deborah Y. Kamin, director of cancer policy at the American Society of Clinical Oncology, rejected that view, saying, "No one believes that the changes in practice expense payments will offset the cuts.'' ( New York Times, 7/28)

-From Kaiser Daily Health Policy Report, “CMS Officials Release Proposed Regulations for Medicare Preventive Care Coverage”, July 28, 2004 at http://www.kaisernetwork.org/daily_reports/rep_index.htm?DR_ID=25002

08/2004