Tuesday, March 23, 2010

With Health Reform, Medicare Now Covers a Prevention Visit With A Doctor: A Look At the Scientific Evidence, Part 2

In yesterday's post, the pernickety Disease Management Care Blog contrasted Speaker Pelosi's victory speech description of the newly passed health bill's prevention provisions with the actual legislative language. While her characterization bordered on bombastic, it's clear that there's a lot of grant money and new government being devoted to prevention. What really caught the DMCB's attention, however, was the decision for Medicare to now pay for an annual visit devoted to the creation of a "personalized prevention plan."

Sounds good right? Imagine being ushered in from the waiting room and huddling with your personal physician, Dr. Nowpaidenuf. Dream about reviewing, sharing and discussing how little you exercise, how much you eat and how unwilling you are to get a colonscopy. Then visualize exiting the clinic with a plan, being thankful that your version of Medicare is under the stewardship of an enlightened political leadership and resolving to eat more vegetables. And fruit.

Sound too good to be true? There's plenty of research to say that it probably is.

While there are plenty of studies (for example) that show that physicians could do better when it comes to counseling their patients about prevention, it turns out that lack of payment has been only a small part of the story, compared to other issues, such as their own lack of confidence or patient barriers that include socioeconomic issues, competing medical conditions, and the lack of motivation. If physicians wade in anyway, their advice can be wrong and, even if they're right, the benefit that patients may get typically decays over time. No wonder the U.S. Preventive Services Task Force has concluded there is no evidence that primary care counseling works to meaningfully increase physical activity and that a very thorough review of the medical scientific literature found no evidence to support the notion that counseling alone has any sustained impact on obesity.

While the DMCB is thankful, that's because a certain Ms. Anderson has thrown her hat, plus ample amounts of fruit, into the ring of Dancing With The Stars. Armed with that inspiration, the DMCB thinks it's ironic that, just when Medicare is emphasizing value based purchasing, Congress has created an additional entitlement that, by itself, has little apparent value.

But all is not lost. The DMCB ultimately thinks that there is plenty of value to be had in prevention counseling. More on that in a Part 3 post tomorrow.

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