Medicare To Cover Initial Physical Exam for New Beneficiaries

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 changes enacted in the new Medicare law, under plans announced Tuesday by federal officials, the New York Times reports. 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.

Medicare also would cover biannual 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).

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," HHS 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). CMS Administrator Mark McClellan said, "I know how important it is to have not only good coverage for preventive tests to get better outcomes, but also coverage that provides access to high-quality physician services" (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" (New York Times, 7/28). Dr. Kate Ackerman, a gerontology specialist at Boston University, said the initial physical examination "gives the physician a chance to counsel and spend time with a patient, doing a thorough review of their health." But Tillyruth Teixeira, a board member of the Massachusetts Senior Action Council, said, "This is not where the major thinking needs to be done," adding that beneficiaries who want to get preventive care likely already do so (Boston Herald, 7/28).