-
Views
-
Cite
Cite
Peter A Hollmann, The Medicare Annual Wellness Visit: Challenges and Opportunities in Practice, Public Policy & Aging Report, Volume 29, Issue 1, 2019, Pages 5–7, https://doi.org/10.1093/ppar/pry049
Close - Share Icon Share
Extract
Once upon a time, Medicare did not cover preventative services. In July of 1965, when Medicare became law, the goal was “To provide a hospital insurance program for the aged under the Social Security Act with a supplementary medical benefits program and an expanded program of medical assistance, to increase benefits under the Old-Age, Survivors, and Disability Insurance System, to improve the Federal-State public assistance programs, and for other purposes.” (available at https://www.govinfo.gov/content/pkg/STATUTE-79/pdf/STATUTE-79-Pg286.pdf) Like all health insurance of the day, it was not about promoting health; it was about payment for sickness care. For example, before 1988, when Medicare first began to cover screening mammography, women only had diagnostic mammograms for abnormal findings on clinical breast examinations. While traditional Medicare continued to limit coverage of preventative services for decades to come, in 1973, Medicare was expanded to include Health Maintenance Organizations (now Part C Medicare Advantage Plans), which explicitly recognized wellness and prevention as key components of clincial care. In 2009, Medicare began paying for the only preventative “physical” it covers today: the Initial Preventative Physical Exam (IPPE), which is available once in the life of a beneficiary, if performed within the first 12 months of Part B enrollment. Medicare did seek geriatrics expertise on implementing the IPPE benefit; the challenge of giving advice was to make it consistent with geriatric principles of care for a relatively young population, but also to not make the requirements so extensive as to be incompatible with the daily challenges of primary care. An even greater challenge was reconciling medical science with the “Congressional science,” which required that any “real” physical include a screening electrocardiogram (EKG).
