Medicare Urged to Cover
Preventive Health Services
Excerpt By Karen Pallarito, Reuters Health

To improve the health of older and disabled Americans, Medicare should cover services that prevent disease, such as cholesterol, vision and hearing screenings, instead of focusing almost exclusively on treating people once they get sick, according to a report released Tuesday by the Partnership for Prevention.

While Medicare decides whether to pay for certain treatments for beneficiaries who are ill, it takes an act of Congress to add coverage for services that may prevent illness in the first place.

"Congress doesn't and can't act instantaneously ... Therefore, Medicare is perpetually behind the curve," said John Clymer, the Partnership's president.

The report recommends that the Centers for Medicare and Medicaid Services be given the same decision-making authority for prevention that it has for treatment.

It also urges Medicare to follow the recommendations of the U.S. Preventive Services Task Force, an advisory panel convened by the U.S. Department of Health and Human Services that reviews the latest scientific evidence for and against preventive services.

Relying on Congress to add preventive services to Medicare has resulted in patchwork coverage and a confusing array of cost-sharing requirements, the report said.

Medicare now covers only half of the preventive services experts recommend for the 65-and-older population.

"Some preventive services that provide great benefits at a low cost are overlooked in favor of other services that do not meet the evidence standards to be recommended but have effective political advocacy groups," according to the report.

"We all know that the Medicare program has not kept pace with the best of modern medicine in many areas, including preventive care," Senate majority leader Bill Frist, R-Tenn., said in a statement.

"The Partnership report is a timely and important reminder that the program must be strengthened and improved to continue meeting the health needs of our nation's seniors."

Clymer said the Partnership has shared its findings with Republican and Democratic members of Congress and senior officials of the Bush administration and has received very favorable reaction.

At the administration's request, the Partnership conducted a separate analysis of the costs and benefits of adding various preventive services using a methodology similar to the one used by the Congressional Budget Office.

Adding vision screening, at a cost of $18 million over 10 years, would save $128 million by reducing an estimated 21,000 hip fractures by preventing falls, the study showed.

Cholesterol screening, which would cost an average of $82 million per year over a decade, would generate a net savings by the 7th year, as the benefits of fewer heart attacks and strokes were realized, the analysis showed.

Stopping tobacco use would cost 40 cents per member per year over the first 10 years, for a net savings of $19.5 million and 95,000 years of life.

Clymer said the study shows there is substantial room for improving Medicare for the 40 million Americans currently in the program and for future beneficiaries. The enhancements should be considered, he said, as part of an overhaul of the Medicare program.

"Instead of Congress just saying, 'How do we tack on prescription drug coverage?' the question they should be asking is, 'How do we modernize Medicare and make it a better program to keep seniors healthy, instead of mainly focusing on treating them when they get sick? And how do we make Medicare a more cost-effective program?"' Clymer said.

Reference Source 89

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