Patchwork coverage: Medicare's preventive services

During the program's life span, services have been woven in piecemeal, leaving gaps in what Medicare will pay for.

By Jane Cys, AMNews staff. Feb. 26, 2001.

Medicare currently offers a patchwork of preventive services -- from flu shots to mammograms and colonoscopies, but geriatrician Holly Stanley, MD, doesn't think that's enough. She believes the program should also pay for an annual preventive services visit that would give busy physicians time to review with patients all the preventive services that might benefit them.

"Medicare is so fragmented. What's really needed for seniors is a more consolidated comprehensive approach to their care that doesn't just focus on the traditional medical things," said Dr. Stanley, who runs a Richmond, Va., private practice called Coordinated Care for Seniors. "Frankly, it would save Medicare a bunch of money."

The fragmented approach to preventive services isn't going to be easy to fix, physicians, policy-makers and others agreed. Congress has taken great strides in recent years by adding new preventive services to the Medicare benefits package, but many argue that the program still needs a comprehensive, evidence-based approach.

"Medicare is beginning to reflect more of the kinds of preventive benefits that you see in private health insurance," said Kirsten Sloan, associate coordinator of the federal affairs health team for AARP. "We still have a ways to go."

The biggest obstacle to creating a more logical approach to prevention services is Medicare itself. Congress created Medicare in 1965 -- a time when treatment, rather than prevention, was emphasized.

As a result, Medicare was established to cover primarily hospital and physician services. The original law defines covered services as those that are "reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member." [...]