Really, sit down. Trust me, please. You are going to be shocked with the news I am going to give you and I don’t want any contusions, closed head injuries, street riots, or revolutions taking place in South American countries on my conscience.
Are you sitting? OK, here it goes:
Medicare got something right.
Pretty crazy, right? I am not sure if it was an accident, like the infinite monkeys typing on a keyboard producing the works of Shakespeare (they’d write all of the Harlequin romance novels too, by the way). They had to eventually do something right, something that really benefits people, makes my life better, and potentially cuts cost. The thing they got right? The Medicare preventive exam.
Up to a year ago, the only way I would ever get paid to see a Medicare patient was when they had a problem. If a person came in with the desire to keep from being sick, we would have to get a waiver signed and charge them full price. So at those visits we would fish for any problems to justify it as a disease-management visit or one for acute care. This meant that any prevention that I did perform on my Medicare patients had to be done on the side during problem-oriented visits. So the motivation to do prevention was dependent on the nature of the doc; if they are OCD, didn’t care about getting home on time, or less concerned about getting paid, patients got better care, otherwise it was hit or miss.
Plus, the chart itself was often neglected. Any time a doctor took to make the chart accurate was time away from other patients or time away from home. This sounds petty, but it takes a large effort to keep things updated, and with the low reimbursement of primary care, only those things that were grossly inaccurate got corrected in most patients’ records. I was never given the time to make sure the records were accurate.