Medicare

More “free” benefits under Medicare; creating new services when it is not necessary, can we legislate common sense?

Medicare has announced a new service that it will pay for in full.  I have highlighted in bold and red below the new service. Is it a good service, I guess.  So, let’s think about this, why wouldn’t this be part of a normal office visit?  Why wouldn’t this type of discussion take place during the course of ongoing treatment or following with one’s doctor?  Perhaps it does in many cases; certainly there is a great deal of promotion of a healthy diet.  And I have another question, at age 65 and over just how much prevention can take place, can a life’s worth of poor habits be wiped out to the extent there is prevention of potential cardiovascular disease? 

My objection with all this is not with the goal of helping people, rather it is with the idea that making more and more “free” is helpful to anyone.  In addition, we continuously fail to conduct a real cost benefit analysis on what we do.  This benefit would make more sense for forty-five year olds would it not, yet we seem to direct more and more of our limited resources at the oldest segment of our population at the expense of the other 250 million Americans.

 Medicare expands coverage of cardiovascular disease prevention services

New, free preventive services for Medicare beneficiaries support Million Hearts initiative  

The Centers for Medicare & Medicaid Services (CMS) today announced that Medicare is adding coverage for a number of preventive services to reduce cardiovascular disease.  This new coverage policy will add to the existing portfolio of free preventive services that are now available for people with Medicare, thanks to the Affordable Care Act.  It contributes to the Million Hearts initiative led jointly by CMS and the Centers for Disease Control and Prevention in partnership with other HHS agencies, communities, health systems, nonprofit organizations, and private sector partners across the country to prevent one million heart attacks and strokes in the next five years. 

“Access to preventive services helps Medicare beneficiaries identify health risk factors and disease early to provide greater opportunities for early treatment,” said CMS Administrator Donald M. Berwick, M.D.  “CMS continues to carefully and systematically review the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible.”  

Under this coverage decision, CMS will cover one face-to-face visit each year to allow patients and their care providers to determine the best way to help prevent cardiovascular disease. The visit must be furnished by primary care practitioners, such as a beneficiary’s family practice physician, internal medicine physician, or nurse practitioner, in settings such as physicians’ offices.  During these visits, providers may screen for hypertension and promote healthy diet as part of an overall initiative to reduce the burden of cardiovascular disease in the United States. 

Cardiovascular disease characterizes conditions affecting the heart and blood vessels, including hypertension, coronary heart disease, heart failure and stroke.  Cardiovascular disease is also the leading cause of mortality in the United States. Today’s new coverage policy does not change current Medicare coverage for beneficiaries diagnosed with cardiovascular disease to receive assessment and intervention services.     

Earlier this year, the U.S. Department of Health and Human Services announced its Million Hearts national initiative, aimed at preventing a million heart attacks and strokes in the U.S. by 2017. Through Million Hearts, CMS, the CDC and other HHS agencies are working together with public and private sector organizations to make a long-lasting impact against cardiovascular disease. 

“This coverage decision reinforces CMS’ commitment to the work of the Million Hearts initiative,” said Patrick Conway, M.D., CMS chief medical officer and director of the Agency’s Office of Clinical Standards and Quality. “One of the main ways we will prevent cardiovascular disease in this country is to empower Americans to make heart-healthy lifestyle changes, and Medicare’s new cardiovascular disease preventive services will allow more beneficiaries to do just that.” 

For more information about Million Hearts, please visit  millionhearts.hhs.gov. To read the new policy, visit the CMS website at: http://www.cms.gov/medicare-coverage-database/details/nca-decision-memo.aspx?NCAId=248

Advertisements

Categories: Medicare

3 replies »

  1. Not sure if you are Medicare age but — if not — this is how it works:
    — Before you are Medicare age, most decent insurance policies include an annual physical where all the above and many additional things are included (such as asking you to say ahh to check I’m not sure what, putting their stethoscope on your chest and back, and so forth as well as particularly for men, physicl prostrate exams and seeing if you can cough sideways while your whatsis are being held). The insurers, trying to hold down their overall expenses long term, include these physicals “free” annually and highly encourage you to get one annually after you’re turned 50 (often your doctor’s office or the insurer will call you if they haven’t seen you in 14-15 months, particularly if you take meds for hypertension or chlosterol
    — When you reach 65 and go on Medicare, your new mandated insurer, the government, does not care about its long term costs. So under Original Medicare, it covers only once such physical exam for the rest of your life. The Patient Protection and Affordable Care Act felt that was not smart but rather than simply adding physicals as a benefit, it treats all of it separately and calls them separate vfisits the prostrate exam, the coughing sidewas, the taking of blood pressure readings and weight

    Like

    • I am on Medicare and I designed and managed health benefit plans for nearly fifty years before I retired last year. I think my observations on the new “benefit” are still valid though. It encourages unbundling of charges and services just all the new preventive service requirements for the non Medicare population do.

      Dick

      Richard D Quinn Editor Quinnscommentary.com

      Like

  2. Good post Mr. Quinn.
    For larger government to move toward more socialism the idea of cost benefit analysis must be avoided . Free is a relative term. The individual sees it as free if he doesn’t bear the cost, but everything has a cost. The collective bears the cost but the individual disassociates himself and thinks the service free.

    Like

What's your opinion on this post? Readers would like your point of view.

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google photo

You are commenting using your Google account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s