Encouraging Patients to Comply with Preventive Exams

For physicians like myself who trained in the early 2000s, the concept of preventive exams was always encouraged, but the prior lack of coverage was always a problem. Patients were previously negatively reinforced to have preventive exams for several reasons. First, the encounter was never covered by insurance plans. If patients did present for a physical, the payment responsibility was left solely with them. Second, insurers viewed such preventive exams as additional costs to their system; therefore such exams were not encouraged.

Now that CMS provides coverage for a Medicare Annual Wellness Visit annual wellness visit, it has largely become difficult to encourage patients to come in for these exams. Patients are concerned about additional costs and it has been very difficult to get them to schedule these visits. My practice has reacted to this proactively. We are informing patients of the benefit available to them and also informing them that there will be no out-of-pocket copayments and deductibles do not apply. With no prior coverage for these exams in place, physicians were responsible for insuring that patients were getting pap smears, mammograms, prostate exams, etc. The provision of these services was incorporated into routine follow-up visits and would increase the amount of time that we would spend in the exam room with each patient.

CMS has certain requirements that must be met for the annual wellness visit. Fortunately, my EHR provider has created a template for the history that enables me to accurately and rapidly collect the needed bullets to satisfy the coding requirements. However, getting the patients to actually come in for these exams still remains a large problem. An additional problem of providing this preventive visit is that CMS will not separately reimburse for any problem-related E&M service provided on the same calendar day for the initial preventive visit.

As physicians, we know that if we are given the appropriate amount of time to spend with our patients, we can recommend the necessary screening tests to be performed. It is much easier to identify potential problems and treat those problems earlier rather than later. Not only does this result in better outcomes for our patients, it results in much better patient care.

There is no easy way to encourage patients to come in for these exams. Only the provision of proper education to the patient will result in the desired outcomes. The insurance companies and CMS have finally realized that if physicians are able to screen for disease earlier, rather than later, we can actually make a difference in the health and well-being of our patients.

My wish for CMS and the insurance companies would be for them to proactively contact each patient and encourage them to present for these preventive exams. Not only does it result in better outcomes for the patient, but it also provides better reimbursement for the cognitive services involved in providing such prevention.

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