If you are not a Medicare patient this information and discussion may not be of interest to you. But if you are a Medicare patient, I am going to try to explain what I know about the wellness exams that Medicare offers. This has been confusing to me and I think it is confusing to patients also. The federal government, who runs Medicare, has come up with a policy that offers “wellness” visits at no cost. The problem for patients and providers is defining what a wellness visit is.
Most people consider this visit a “Physical.” Traditionally a physical has included an actual head to toe examination along with screenings for problems like high blood pressure, cancers, cholesterol, and diabetes along with addressing medical problems and updating immunizations. However, Medicare has established their own specific guidelines for what they consider a “wellness” visit to be. It is modeled after the concept of an HRA (Health Risk Assessment) which has been discussed in a previous article.
During the first year of Medicare coverage a “Welcome to Medicare” visit would be offered. Thereafter, a yearly “subsequent wellness visit” would be offered. If the “welcome to Medicare” visit is not done the first year, an “initial” visit can be done at a later time.
During the visit, medication use, medical history and family history would be reviewed. Questioning to screen for risk of falls, risk of depression, hearing loss, and signs of memory loss would be asked. In addition the issue of advanced directives for health care would be raised. The blood pressure, height and weight would be measured and BMI calculated. Also smoking and alcohol use would be assessed and treatment referral offered. Patients who are eligible for certain defined screening tests could have them scheduled and they would be covered.
Screening tests that would be covered include cancer screenings like PAP smear, colonoscopy, mammogram, and PSA when indicated. Also screening for cardiovascular risk factors including glucose and cholesterol profile measurements would be covered. An ultrasound exam of the abdominal aorta to screen for an aneurysm is covered for men over 65 who had ever smoked. In addition, a bone density test is covered for those who qualify. Some vaccinations are covered including an annual flu shot and pneumococcal vaccine.
So what is not covered? This is where it gets tricky. The visit does not cover a detailed exam or evaluation of any complaints/concerns, medication refills, disease management, and lab tests other than screening. So this does not meet the definition of what most people think of as a complete physical.
Honestly, there are very few Medicare patients who are not taking medications and who do not have some concerns about their health. Medication and disease management are not covered by the Medicare wellness exam. So, when the provider charges for taking time to examine, evaluate and manage medical problems, patients may end up with a bill. This is a problem because many people expect everything to be covered by the “wellness visit”.
So, it may be best to think of the Medicare wellness visits as a form of an HRA and recognize disease management and testing would be separate. Details about what preventive services are covered by Medicare can be found on line at www.medicare.gov. Stay healthy my friends.
By: P. Michael Shattuck, M.D. – Community Health Network Family Physician
